Abstract

Emerging evidence suggests that host-microbe interaction in the cervicovaginal microenvironment contributes to cervical carcinogenesis, yet dissecting these complex interactions is challenging. Herein, we performed an integrated analysis of multiple “omics” datasets to develop predictive models of the cervicovaginal microenvironment and identify characteristic features of vaginal microbiome, genital inflammation and disease status. Microbiomes, vaginal pH, immunoproteomes and metabolomes were measured in cervicovaginal specimens collected from a cohort (n = 72) of Arizonan women with or without cervical neoplasm. Multi-omics integration methods, including neural networks (mmvec) and Random Forest supervised learning, were utilized to explore potential interactions and develop predictive models. Our integrated analyses revealed that immune and cancer biomarker concentrations were reliably predicted by Random Forest regressors trained on microbial and metabolic features, suggesting close correspondence between the vaginal microbiome, metabolome, and genital inflammation involved in cervical carcinogenesis. Furthermore, we show that features of the microbiome and host microenvironment, including metabolites, microbial taxa, and immune biomarkers are predictive of genital inflammation status, but only weakly to moderately predictive of cervical neoplastic disease status. Different feature classes were important for prediction of different phenotypes. Lipids (e.g. sphingolipids and long-chain unsaturated fatty acids) were strong predictors of genital inflammation, whereas predictions of vaginal microbiota and vaginal pH relied mostly on alterations in amino acid metabolism. Finally, we identified key immune biomarkers associated with the vaginal microbiota composition and vaginal pH (MIF), as well as genital inflammation (IL-6, IL-10, MIP-1α).

Highlights

  • Despite the availability of preventive measures, such as human papillomavirus (HPV) vaccination and Pap smear screening, cervical cancer remains a major public health problem, in low- and middle-income countries [1]

  • We established predictive models and identified key signatures related to vaginal microbiota, vaginal pH and genital inflammation

  • Metabolomics data was predictive of different features of the cervicovaginal microenvironment and host response but integrating multi-omics data is likely to be essential for realizing the advances promised by microbiome research

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Summary

Introduction

Despite the availability of preventive measures, such as human papillomavirus (HPV) vaccination and Pap smear screening, cervical cancer remains a major public health problem, in low- and middle-income countries [1]. Infection with high-risk HPV types is a wellestablished risk factor for cervical cancer [2], but is not sufficient for development of the highest risk precancerous cervical dysplasia and progression to cancer [3] This suggests that other factors in the local cervicovaginal microenvironment play a role during cervical carcinogenesis [4]. The cervix and vagina in the majority of healthy, reproductive-age women are colonized by one or few Lactobacillus species [7]. These beneficial microorganisms produce lactic acid (lowering vaginal pH, typically below 4.5) and other antimicrobial products. During dysbiosis Lactobacillus spp. are depleted and replaced by a diverse consortium of anaerobes, resulting in elevated vaginal pH [10,11]

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