Abstract
Immune dysregulation can involve invasion and survival of endometrial glands inside the myometrium of the adenomyosis. There is limited available data concerning alterations of the bacterial microbiome in the reproductive tract of adenomyosis women. The present cross-sectional age-matched study aims to compare vaginal microbiota between women with and without adenomyosis. We recruited women with adenomyosis (N = 40) and age-matched women without adenomyosis (N = 40) from the Departments of Obstetrics and Gynaecology, Ramathibodi Hospital Mahidol University, from August 2020 to January 2021. Vaginal swab samples were collected from the participants. DNA isolation and bacterial 16s rDNA gene sequencing and data analyses were then performed. Comparison of the diversity of vaginal microbiota, microbiota composition, and the operational taxonomic unit (OTU) between adenomyosis and non-adenomyosis (control) groups were undertaken. Data from 40 and 38 women with and without adenomyosis, respectively, were analyzed. Alpha-diversity analysis (Chao1 index) at the species level showed higher vaginal microbial richness in the adenomyosis group when compared with the control group (p = 0.006). The linear discriminant analysis effect size technique (LeFSe) indicated an elevated abundance of several vaginal microbial taxa in the adenomyosis group, including Alloscardovia, Oscillospirales, Ruminoccoccaceae, UCG_002, Oscillospiraceae, Enhydrobacter, Megamonas, Moraxellaceae, Subdoligranulum, Selenomonadaceae, and Faecalibacterium. On the other hand, an increase in the abundance of Megaspehera, Fastidiosipila, Hungateiclostridiaceae, and Clostridia was identified in the control group. Vaginal community state type (CST)-III and -IV were dominated in adenomyosis, while only CST-IV was dominated in the non-adenomyosis group. Lactobacillus was the most abundant vaginal microbial in both groups. In this study, the differences in vaginal microbiome profile were noted between adenomyosis and non-adenomyosis group. The increasing of microbial richness was associated with adenomyosis. Nevertheless, further investigations were required to elucidate the mechanisms and apply them for clinical implications.
Highlights
Adenomyosis is a benign uterine myometrium lesion that is commonly found in women of reproductive age
The vaginal samples were collected from all participants; two samples were excluded from the control group due to poor DNA quality after library quality check
Medians and interquartile ranges (IQRs) of the number of operational taxonomic unit (OTU) identified in each sample were 25.00 and 10.50 and 21.00 and 8.75 in the adenomyosis and control groups, respectively
Summary
Adenomyosis is a benign uterine myometrium lesion that is commonly found in women of reproductive age. Data from previous studies demonstrate that a vicious cycle of immune dysregulation exists involving invasion and survival of endometrial glands inside the myometrium of the adenomyosis [4, 5]. An alteration of immune factors within the eutopic endometrium was proposed to play a role in the invasion mechanism [5]. Elevation of immunosuppressive cytokines, including interleukin (IL)-10, was observed to be a survival mechanism of the ectopic endometrium in both ectopic and eutopic endometrial glands of adenomyosis [6]. This observation is linked to the survival mechanism of endometrial glands within the myometrium without eradication by the immune system. The precise immune dysfunction contributing to adenomyosis development is not completely understood
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