Efficacy Comparison of Oral and Intravaginal Lactobacillus plantarum Administration on Secreted Aspartyl Protease-5 (SAP5) Levels in Vulvovaginal Candidiasis

Abstract

Vulvovaginal candidiasis (VVC) is the most common fungal infection in the vaginal mucosa caused by an overgrowth of Candida albicans. The pathogenesis of C. albicans is determined by the presence of virulence secretory factors. Secreted Aspartyl Protease 5 (SAP5) is the dominant virulence factor that plays a critical role in the morphology switching of yeast cells into hyphae which causes tissue invasion and induces an immunopathological response. Levels of SAP5 are often associated with the severity various types of infection. As a potential supportive therapy to treat VVC, identification of the probiotic’s administration route determines the level of efficacy of probiotics. This study aims to compare the decrease in SAP5 levels between oral and intravaginal administration of L. plantarum. The study was true experimental using a completely randomized pretest-posttest group design. There were 32 female rats were divided into 8 groups i.e negative control, positive control, 3 groups of oral and 3 of intravaginal administration. Positive control and 6 treatment group were injected with estradiol valerate 0.5 mg and then inoculated with suspension of C. albicans 2×107 CFU to create VVC model. L. plantarum was administered orally and intravaginally with 3 concentration variants i.e. 2.25×1010, 4.5×1010 and 9×1010 CFU. Both of oral and intravaginal group were given with probiotics for 14 days. SAP5 levels were measured by ELISA from vaginal lavage sample. The statistical analysis used was the Paired T-Test to measure SAP5 levels pre-post oral and intravaginal administration of L. plantarum. The results showed a significant decrease in SAP5 levels in oral administration (p = 0.001 < 0.05) and intravaginal administration (p = 0.000 < 0.05). From the results of the statistical analysis, it can be concluded that both oral and intravaginal administration of the probiotic L. plantarum has the same efficacy in reducing the virulence factor of C. albicans in cases of VVC. HIGHLIGHTS Lactobacillus plantarum is potential supportive therapy for Vulvovaginal Candidiasis Efficacy plantarum identified through oral and intravaginal administration SAP5 is an important virulence factor in pathogenesis of Vulvovaginal Candidiasis Efficacy’s rate plantarum was analyzed based on SAP5 levels in vaginal fluid GRAPHICAL ABSTRACT