Molecular detection of microbial colonization in cervical mucus of women with and without endometriosis Original paper
Researched by:
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Kimberly Eyer
ID
Kimberly Eyer
Kimberly Eyer, a Registered Nurse with 30 years of nursing experience across diverse settings, including Home Health, ICU, Operating Room Nursing, and Research. Her roles have encompassed Operating Room Nurse, RN First Assistant, and Acting Director of a Same Day Surgery Center. Her specialty areas include Adult Cardiac Surgery, Congenital Cardiac Surgery, Vascular Surgery, and Neurosurgery.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Endometriosis
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
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Kimberly Eyer
Researched by:
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Kimberly Eyer
ID
Kimberly Eyer
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Karen Pendergrass
What Was Studied?
This study investigated the molecular detection of microbial colonization in cervical mucus of women with and without endometriosis using next-generation sequencing (NGS) technology. The primary aim was to explore whether specific microbial populations in the cervical mucus are associated with endometriosis and could contribute to its pathogenesis. Researchers collected cervical mucus samples from 30 women with endometriosis and 39 women without the condition. The microbial communities were analyzed through 16S rRNA gene sequencing, alongside Gram staining and real-time PCR to validate the presence of specific bacterial species. This study sought to identify microbial signatures that may play a role in the inflammation and immune responses linked to endometriosis progression.
Who Was Studied?
The study included 69 women of reproductive age, with 30 diagnosed with endometriosis (all classified as r-ASRM stages III-IV) and 39 serving as healthy controls. All participants underwent laparoscopic surgery for diagnosis or benign gynecological conditions. Cervical mucus samples were collected before surgery under sterile conditions to prevent contamination, ensuring accurate representation of the microbiota present. Women with gynecological malignancies, pelvic inflammatory disease, bacterial vaginosis, or recent antibiotic use were excluded to prevent confounding microbial shifts.
What Were the Most Important Findings?
The analysis revealed that cervical mucus in women with endometriosis harbored distinct microbial communities compared to healthy controls. While Lactobacillus spp. remained dominant across all samples, women with endometriosis showed increased populations of Enterobacteriaceae, Streptococcus, Corynebacterium, Pseudomonas, and Flavobacterium. Notably, Enterobacteriaceae and Streptococcus were significantly enriched in endometriosis patients, as confirmed by real-time PCR analysis (p <0.05). This elevated presence suggests these bacteria may contribute to inflammatory cascades in the cervix and potentially facilitate disease persistence. Additionally, alpha diversity was significantly higher in the cervical mucus of endometriosis patients, indicating a broader microbial distribution. The study also noted that despite high Lactobacillus prevalence (40–60%), the co-existence of pathogenic bacteria like Enterobacteriaceae and Streptococcus was unique to the endometriosis group, hinting at microbial imbalance. These findings support the hypothesis that cervical microbial colonization could be linked to the development and maintenance of endometriosis through immune modulation and inflammatory responses. The study further postulated that the ascent of these pathogens from the cervix into the uterine cavity may exacerbate inflammatory conditions, potentially triggering endometriosis progression via LPS/TLR4 signaling and innate immune activation.
| Parameter | Findings in Endometriosis Patients |
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| Dominant Genera | Lactobacillus spp. remained dominant in both endometriosis patients and controls, with 40–60% prevalence. |
| Increased Genera | Marked increases in Enterobacteriaceae, Streptococcus, Corynebacterium, Pseudomonas, and Flavobacterium. |
| Significant Enrichment | Enterobacteriaceae and Streptococcus were significantly enriched (p <0.05) in the endometriosis group. |
| Alpha Diversity | Higher alpha diversity observed in endometriosis patients, indicating broader microbial distribution in cervical mucus. |
| Pathogenic Co-Existence | Despite high Lactobacillus prevalence, Enterobacteriaceae and Streptococcus co-existed exclusively in the endometriosis group. |
| Inflammatory Associations | These pathogens are suspected to drive inflammatory cascades, contributing to lesion persistence and immune dysregulation. |
| Migration Hypothesis | Potential pathogen ascent from the cervix to the uterine cavity may exacerbate inflammation and promote endometriosis via LPS/TLR4 signaling and innate immune activation. |
What Are the Greatest Implications of This Study?
The study provides compelling evidence that specific microbial communities in cervical mucus—particularly Enterobacteriaceae and Streptococcus—are associated with endometriosis. This microbial imbalance suggests that the cervical microbiome may serve as both a diagnostic biomarker and a therapeutic target for endometriosis management. The findings highlight the possibility of cervical microbial migration into the uterine cavity as a driver of inflammation and lesion growth, underscoring the need for further exploration into microbiota-targeted therapies. By identifying microbial dysbiosis at the cervical level, this study opens the door to non-invasive diagnostic methods and preventive strategies aimed at reducing microbial-induced inflammation in endometriosis patients.