A Vaginal Microbiome Transplant Could Help People With BV

This episode explores the potential benefits of vaginal microbiome transplants for treating bacterial vaginosis (BV), featuring research by Fatima Aisha Hussain.

1. Bacterial Vaginosis: Affects about 30% of women worldwide and is characterized by symptoms like fishy odor and discomfort.
2. Microbiome Transplants: These involve transferring vaginal secretions from healthy donors to BV sufferers to potentially establish a healthier microbiome.
3. Challenges of Treatment: High recurrence rates of BV post-antibiotics highlight the need for new treatment methods like microbiome transplants.
4. Research Insights: Initial pilot studies show promise, with some participants maintaining a healthy microbiome state for up to six months post-transplant.
5. Future Directions: Continued research will explore optimal donor-recipient matching and the mechanisms underlying successful microbiome transplants.

1: Introduction to Bacterial Vaginosis

Overview of BV, its impact on women's health, and the high global prevalence. Insights into the symptoms and challenges of current treatments. Fatima Aisha Hussain: "About 30% of women worldwide have bacterial vaginosis."

2: Exploring Microbiome Transplants

Discussion on the potential of vaginal microbiome transplants as a treatment, including the process and challenges of donor selection. Emily Kwong: "How does the donation process actually happen?"

3: Results from the Pilot Study

Details from the initial safety study, including the outcomes for participants and the implications for future research. Fatima Aisha Hussain: "Our donor had nearly 100% lactobacillus crispatus, a relative abundance in her vaginal microbiome."

1. Awareness of BV and its symptoms.
2. Consider alternative treatments if recurring issues persist.
3. Participate in or support research in women's health.
4. Educate oneself about the importance of microbiomes in health.
5. Stay informed about new health studies and findings.

Humans rely on our symbiotic relationship with good microbes—in the gut, the skin and ... the vagina. Fatima Aysha Hussain studies what makes a healthy vaginal microbiome. She talks to host Emily Kwong about her long-term transplant study that asks the question: Can one vagina help another through a microbe donation?

People

Fatima Aisha Hussain, Emily Kwong

Companies

Reagan Institute of MGH, MIT, Harvard

Books

None

Guest Name(s):

None

Content Warnings:

None

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Emily Kwong
You're listening to short wave from NPR.

Today, in celebration of Women's Health Month, we are going to dive into the work of Fatima Aisha Hussain, who has been asking questions about microbes, questions about.

Fatima Aisha Hussain
How the different microbes there are evolving and interacting with each other and their ecosystem, which happens to be the vagina.

Emily Kwong
Fatima studies the vagina.

D
Really?

Emily Kwong
She studies the vaginal microbiome as a postdoctoral research scientist at the Reagan Institute of MGH MIT in Harvard.

Fatima Aisha Hussain
I've definitely been obsessing over vaginas for a while. I started out studying environmental engineering and women's and gender studies in undergrad, and then I hopped over to microbiology. And now I get to combine radical feminism with microbiology in this really cool way.

Emily Kwong
Before studying the vaginal microbiome, Fatima researched microbes in the ocean.

Fatima Aisha Hussain
So I hope to use what I learned in how bacteria evolve in the ocean and apply it to understanding how bacteria are evolving in the human vagina.

Emily Kwong
And in studying the vagina, Fatima wants to focus on helping people fighting a condition called bacterial vaginosis, or BV.

BV is an imbalance of microbes in the vagina, and that can lead to poor health outcomes like preterm birth, higher susceptibility to STI's, and higher rates of cervical cancer. So in searching for new treatment options, Fatima recently completed a pilot study looking at whether a microbe transplant could benefit people with recurrent BV infections.

Fatima Aisha Hussain
Dreams for the study is to actually understand the vaginal ecosystem better and understand why certain transplants work in certain people, why they don't. And all those questions will help us in one day design therapies that may actually be useful.

Emily Kwong
And therapies are much needed for BV because recurrence can be as high as 50%.

Generally, scientists have not made studying the vagina a priority, and this fuels Fatima's passion for this work all the more.

Fatima Aisha Hussain
Traditionally, people haven't been focused on women's health and on scientific endeavors to move women's health forward, especially women's sexual health.

Emily Kwong
Today on the show, we are rolling out the red carpet for the vaginal microbiome and asking, is it possible for vaginas to help one another? Through a microbe donation, Fatima shares insights from her recent vaginal transplant pilot study. I'm Emily Kwong, and you are listening to short Wave, the Science podcast from NPR.

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Emily Kwong
Cancer.Org dot so vaginal microbiome, it's like a fancy term that just means a community of microbes that live in the vagina. Can you describe what an optimal vaginal microbiome community looks like?

Fatima Aisha Hussain
Yeah. So in a vaginal microbiome, that's, let's say, associated with beneficial sexual and reproductive health outcomes, that would be a low diversity microbiome. You'd see one particular species, lactobacillus crispatus, typically other lactobacilli are also present that dominates, and basically, lactobacilli produce lactic acid, hence the name, and they create this acidic environment and a niche for only them to thrive. But there's also a high diversity vaginal microbiome, and that's the vaginal microbiome that's often associated with poorer health outcomes.

Emily Kwong
That idea sounds pretty different than actually the gut microbiome, where overall, it's good to have high biodiversity of microbes. There's. Is that right?

Fatima Aisha Hussain
Yeah. You know, in the gut, the more diversity you have, the more different bacteria are there to break down different foods you're eating.

But in the vaginal microbiome, yeah. We want, like, a lower diversity state because that is, you know, decreasing inflammation and keeping you what we think is healthy, right?

Emily Kwong
Yeah. It's just one example of what makes the gut microbiome so different. Okay, so, Fatima, when we look at the vaginal microbiome, the biome itself can be characterized as healthy or unhealthy. When it's unhealthy, what happens?

Fatima Aisha Hussain
Yeah, so I will say that we don't exactly know and can define healthy and unhealthy quite yet. We refer to it as a non optimal vaginal microbiome only because many women with diverse vaginal microbiomes don't exhibit any symptoms of having poor health, but it's associated with having a higher susceptibility of acquiring HIV.

Bacterial vaginosis, you can also have increased risk of acquiring lots of other STI's. And again, the focus of HPV and causing cervical cancer is definitely something that's a concern. Then, on the reproductive side, this diverse vaginal microbiome is actually associated with preterm.

Emily Kwong
Birth, bacterial vaginosis, or BV. What is it, and how common is it?

Fatima Aisha Hussain
Yeah. So bacterial vaginosis is this complex, diverse colonization of your vagina by these anaerobes. It can lead to increased discharge, like kind of a fishy smelling odor, a lot of discomfort. Obviously, it has a lot of, you know, implications for self confidence and also, like, sexual intimacy, which is a big deal. And about 30% of women worldwide have bacterial vaginosis. So it's definitely probably. That's high. Very high.

Emily Kwong
And it's one in three, almost.

Fatima Aisha Hussain
Yeah. So that's definitely of concern and hasn't really been studied as much as it should be or, you know, there's not that much funding for women's health, and so it's something that we definitely need to address. The other important thing about BV is that it reoccurs. So the current treatments are to take antibiotics, and the antibiotics do get rid of the diverse anaerobes for a short while. It's just that there's a 50% reoccurrence rate of bacterial vaginosis as well.

Emily Kwong
Wow. That is high. So in light of this fact that people can take antibiotics to provide temporary relief from BV, but it comes back half the time. What is your study trying to do?

Fatima Aisha Hussain
So, for the vaginal microbiome transplant, what we're doing is we're trying to figure out if we can take vaginal secretions from a healthy donor and put it into a woman who is suffering from bacterial vaginosis. And basically, can we transplant the microbiome from one community to another?

Emily Kwong
That's really interesting. How does the donation process actually happen?

Fatima Aisha Hussain
Yeah, we have to screen the donors very, very thoroughly. We actually lose 95% of our donors because we're being so thorough. So safety is definitely a big, big concern. We could accidentally not just transplant Sti's, but also remaining sperm, and that would be very bad. To transplant that into a vagina. So we're doing our due diligence to check and screen the donation material, but basically, a healthy donor comes in, we take a menstrual cup, and we collect vaginal fluid from that person. And then when we have the recipients who have reoccurrent bacterial vaginosis, they will come in and also be screened, and they will be given antibiotics.

And then we will add in the vaginal microbiota transplant, which is, again, just the secretion from the healthy donor. And it's as simple as using, like, an eyedropper and putting the donation into the vagina.

Emily Kwong
What are some of the types of things folks are saying as you're going through the process?

Fatima Aisha Hussain
We have a lot of donors who are, you know, so happy to be doing their part to help vaginas. And then on the recipient side, we have people who are suffering from this almost taboo subject that they don't want to talk about. They're really upset that they can't cure this issue that they're having and that they've tried antibiotics probably for many years and haven't been successful. So they're very much desperate to try out anything and are excited about the vaginal microbiome transplant.

Emily Kwong
Okay, so, Fatima, you recently completed a pilot safety study.

That's like a preliminary step before a larger study. And in your safety study, four people got a vaginal microbiome transplant. What were the results?

Fatima Aisha Hussain
Yeah, we designed this eight person clinical trial safety pilot subset with the FDA. And so in this situation, like you said, we have four people who had recurrent bacterial vaginosis, and they were treated with a vaginal microbiota transplantation, a VmT. And then we also had a comparison arm, a placebo arm of four people who had recurrent bacterial vaginosis who actually got a saline placebo from the same time. What we see in the four people who received the transplant is that two of them seem to actually switch from this diverse vaginal microbiome, which is thought to be non optimal, to indeed, a lactobacillus crispatus dominated vaginal microbiome, which is the one that's health associated.

Emily Kwong
Right. And this is the good bacteria that out competes all the other bacteria.

Fatima Aisha Hussain
Yeah. So lactobacillus crispatus is kind of our go to superhero for the vaginal microbiome.

Emily Kwong
And, like, by being that superhero, it reduces inflation inflammation, like you said earlier, and basically keeps your vagina's microbiome in good shape.

Fatima Aisha Hussain
Yeah. Our donor had nearly 100% lactobacillus crispatus, a relative abundance in her vaginal microbiome. And so not only did their microbiomes shift towards a health associated state, it stayed that way for up to six months.

Emily Kwong
Okay, so, Fatima, the transplant didn't work for two participants. Their bacterial vaginosis came back.

Why do you think that happened?

Fatima Aisha Hussain
Yeah, this is like one of the fundamental questions we want to start to answer in this study. So perhaps we need some type of donor recipient match. For example, it could also be that there are bacteria in the vaginas of the non successful transplants that were better at killing or taking over the incoming vaginal microbiota transplantation. Bacteria. There's lots of questions out there, bacteria based and human host based, that we're going to start looking at to see why a certain transplant was successful versus one that wasn't.

Emily Kwong
And is this what you were expecting?

Fatima Aisha Hussain
Honestly, seeing success in 50% of people was very exciting, because, again, these people have tried everything else.

Emily Kwong
Yeah.

Fatima Aisha Hussain
Our bigger study is really going to shed light on what is the ecosystem of the vaginal microbiome.

Emily Kwong
Yeah. So it sounds like you think it'll be successful.

Fatima Aisha Hussain
Yeah. One reason we think that the vaginal microbiome transplant may be successful is not just because it's the analog to the fecal microbiome transplant in the gut, but because in the fifties and sixties, Doctor Gardner, who was a man who, you know, is Gardnerella vaginalis, one of these BV associated bacteria, are named after he transplanted vaginal fluid from women with bacterial vaginosis into healthy women and did indeed induce bacterial vaginosis in them. So we do see transfer, but that was obviously very unethical and messed up, and we're kind of trying to do.

Emily Kwong
The opposite of that, righting those wrongs.

Fatima Aisha Hussain
I think I'm just really excited to be a part of this research that is focused on women's health and really taking advantage of all that we know about this exciting world of microbes to help women and make an impact.

Emily Kwong
It has been extremely, extremely cool to talk to you about this.

Fatima Aisha Hussain
Absolutely. Thank you so much for taking the time and having the interest to talk about vaginal microbiomes.

Emily Kwong
Oh, I'm here for it. I'm so here for it.

To learn more about the motif study, including information for recipients and donors, check out their website, motifstudy.org. dot. That's m Dash s t Dash u d y.org. we'll put a link to that in our episode notes. This episode was produced by Burleigh McCoy. It was edited by Gisele Grayson and our showrunner, Rebecca Ramirez. It was fact checked by Margaret Sereno. The audio engineers were Gilly Moon and Ko Takasugi Chernovan. I'm Emily Kwong. Thank you for listening to short wave from NPR.

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