Abstract
Although human papillomavirus (HPV) infection is a major cause leading to the development of cervical intraepithelial neoplasia (CIN), the relationship between genital microbiome and HPV persistence/clearance is not well established. Loop electrosurgical excision procedure (LEEP) is one of standard treatments of CIN 2/3 globally, yet little is known about how the LEEP influence genital microbiota. We conducted a prospective study of 26 patients with CIN2/3 who underwent analysis of cervical microbiome before and after 3 months of LEEP treatment. Cervical swabs were collected, and microbiomes were analyzed by 16S ribosomal RNA gene sequencing. A decrease of cervical microbial diversity was observed after 3 months of LEEP treatment. Notably, a significant shift from community type of a Prevotella-containing and lack of a consistent dominant species to lactobacillus iners dominated microbiome correlated with LEEP. Particularly, Leptotrichia and clostridium were further decreased after LEEP treatment (P = 0.049 and P = 0.002, respectively). Our results suggest that the cervical microbiome is altered after LEEP treatment in patients with CIN2/3. Further studies with larger sample sizes are needed to validate these findings.
Highlights
Cervical intraepithelial neoplasia (CIN), a premalignant lesion of the uterine cervix, can be histologically divided into three stages (1, 2, and 3)[1]
Using bacterial genera sequence data, samples were classified according to their bacterial communities consistent with previously described cervical microbiome as cervicotypes (CTs)[12]; CT1: primarily composed of non-iners Lactobacillus, CT2: Lactobacillus iners dominated, CT3: Gardnerella dominated, CT4: lack of a consistent dominant species but communities all included Prevotella (Fig. 1A)
An alteration of cervical microbiome was observed in patients of CIN2/3 follow-up three months of loop electrosurgical excision procedure (LEEP) therapy
Summary
Cervical intraepithelial neoplasia (CIN), a premalignant lesion of the uterine cervix, can be histologically divided into three stages (1, 2, and 3)[1]. Studies have demonstrated that microbial dysbiosis may be a risk factor for the development of HPV infection and cervical neoplasia[5,8,9]. A loop electrosurgical excision procedure (LEEP), to remove the dysplastic cells and allow new cells to replace the old ones, is an effective treatment to reduce the risk of cervical cancer. It is widely recognized on the clearance of HPV infection after the successful treatment of CIN using LEEP11. These results raise intriguing questions about cervical microbiome response underlying the LEEP. The results indicated that LEEP treatment altered the cervical microbiome in patients with CIN2/3
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