Modificazioni dell`ecosistema vaginale in menopausa

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1) I lattobacilli….
• Diminuiscono in Gravidanza
• Aumentano in epoca
premenarcale
• Sono completamente assenti in
postmenopausa
• Diminuiscono puerperio
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Età
Età
Estrogeni
Puberta` +
Epitelio
Glicogeno
+
pH
Microbiota
7
Aerobi
Anaerobi
++++
++
3,5 - 4
Lattobacilli
Gardnerella
Gravidanza+ + + +
++
3,5 - 4
Lattobacilli
Gardnerella,
GBS
-
5-6
Fertile
pueperium +
Aerobi
Anaerobi
fecali
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1) I lattobacilli….
• Diminuiscono in Gravidanza
• Aumentano in epoca
premenarcale
• Sono completamente assenti in
postmenopausa
• Diminuiscono puerperio
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Lactobacilli : Historical view
Production of antimicrobial
substances
–
–
–
–
Lactic acid
H2O2
Bacteriocins
Biosurfactant
Estrogen
Glycogen
Lactobacilli
Allows growth of
lactobacilli,
inhibits growth of
pathogenic bacteria
Lactic acid
pH 3.8-4.5
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Lactobacilli : Historical view
Estrogen
Lactobacilli
Glycogen
Lactic acid
pH 5-6
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Menopausa
+
-
7
Aerobi
Anaerobi
fecali
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Vagina : dell`ecosistema
”lattobacillocentrico”vaginale
Età
Età
Estrogeni
Epitelio
Glicogeno
pH
Microbiota
+
Fertile
++++
3,5 - 4
++
Lattobacilli
Gardnerella
Menopausa
+
-
7
Menopausa
HRT
+
-
3,5 - 4
Aerobi
Anaerobi fecali
Lattobacilli ??
Lattobacilli
Gardnerella
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…al microbiota vaginale….
“Microbiota
(and also vaginal microbiota)
is the ecological community
of
commensal, symbiotic,
and pathogenic
microorganisms that literally
share our body space”.
The microbiota is a
‘‘forgotten organ’’
which plays a major
role in health and
disease in Humans
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Indigenous Microbiota
The Human Microbiome Project
Nature, 2007
• 3% individual`s total body mass
• 10 times more numerous than our
own cells
• 100 times more genes
•Culture-based methods allow to
recover <30% of total
microorganisms
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Bacteria distribution in the human body
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Microbiota and woman`s age
What`s happen ?
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2) Tutti i lattobacilli Vaginali ….
• Acidificano l`ambiente vaginale
• Producono batteriocine
• Producono Acido lattico
• Nessuna delle precedenti
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1- Indigenous Vaginal Microbiota in fertile age
Lactobacilli represent more than 95% of vaginal microbiota
1 or 2 lactobacilli from a range of three or four species (mainly
L. crispatus and L. iners, but also L. jensenii and L. gasseri)
Mixed microbial community
Vedi foto crac
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2) Tutti i lattobacilli Vaginali ….
• Acidificano l`ambiente vaginale
• Producono batteriocine
• Producono Acido lattico
• Nessuna delle precedenti
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2- Lactobacillus : several functions
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Vaginal microbiota and woman`s
age
3 -Different microbiota ?
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Vaginal microbiota and woman`s
age
Alteration of microbiota and
menopausal symptoms ?
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2000th
Modern Plagues
•
•
•
•
•
Obesity
Diabetes
Asthma
Metabolic disorders
Menopause
related
pathologies
Alteration of microbiota ??
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2000th
Modern Plagues
•
•
•
•
•
Obesity
Diabetes
Asthma
Metabolic disorders
Menopause
related
pathologies
Alteration of vaginal or gut microbiota ??
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Microbiota and Key points
• Menopausal state
• Vagina
• Gut
• Mouth
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Microbiota and Key points
• Menopausal state
• Vagina
• Gut
• Mouth
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Histochemical Vulnerability of
over 40 yrs women
•Urogenital atrophy
•Cervical plugs (usually protective) thinner
•Vaginal microbiota
Biological risk factor
Individual factors
Environmental risks
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Vagina
• Estrogen loss alters the
urethral and vaginal flora
(pH variation)
• Enteric colonization
(anaerobes, E Coli, GBS)
of the urethra and vagina
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Histochemical Vulnerability of
over 40 yrs women
•Urogenital atrophy
•Cervical plugs (usually protective) thinner
•Vaginal microbiota
Biological risk factor
Individual factors
Environmental risks
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Menopause and Microbiota
• Alteration of microbiota is related to
– Muscular and epithelial layer variation
– Down regulation of complement system
– Activation expression cytokines
– Mucosal immune activity
– Production of acetylcholine with activation of
alfa cholinergic nerves (pain)
– Conversion plasminogen- plasmin (tissue
sensitivity and bleeding)
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3) Il rischio infettivo ….
• E` diminuito in adolescenza
• E` diminuito in menopausa
• E` aumentato in eta` fertile
• Nessuna delle precedenti
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3) Il rischio infettivo ….
• E` diminuito in adolescenza
• E` diminuito in menopausa
• E` aumentato in eta` fertile
• Nessuna delle precedenti
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Flora vaginale e menopausa :
paradigma superato ?
Età
Età
Estrogeni
Epitelio
Glicogeno
pH
Microbiota
+
Menopausa
+
-
Menopausa
HRT
+
-
Aerobi
7
Anaerobi fecali
Lattobacilli ??
3,5 - 4
Lattobacilli
Gardnerella
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4) La flora lattobacillare vaginale in
menopusa…
• Si riduce
• Aumenta
• Rimane Stabile
• Dipende dalla sintomatologia
della donna
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Microbiota and Menopause in
urogenital tract
•
•
•
•
•
Increase of Anaerobes ?
Increase of E. Coli ?
Lactobacilli deficiency ?
Immunological imbalance ?
Tissue alterations ?
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Microbiota and Menopause in
urogenital tract
•
•
•
•
•
Increase of Anaerobes !
Increase of E Coli
Lactobacilli deficiency !
Immunological imbalance !
Tissue alterations !
ALTERATION OF UROGENITAL MICROBIOTA
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4) La flora lattobacillare vaginale in
menopusa…
• Si riduce
• Aumenta
• Rimane Stabile
• Dipende dalla sintomatologia
della donna
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Microbiota and Key points
• Menopausal state
• Vagina
• Gut ?
• Mouth ?
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5) La flora lattobacillare vaginale in
menopausa …
• Ha un reservoir a livello
intestinale
• Si riduce in varieta` di specie
• E` ridotta nei casi di GSM
• Tutte le precedenti
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Why
MICROBIOTA AND MENOPAUSE???
•
•
•
•
•
Increase of Anaerobes !
Increase of E Coli
Lactobacilli deficiency !
Immunological imbalance !
Tissue alterations !
• GI Disfunction ??
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1990 Gut microbial deprivation hypothesis
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“Il CERVELLO ENTERICO”
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“Gut microbial deprivation hypothesis”
The dysbiosis impacts on
health : WHY ??
Allergic disease
Irritable bowel
syndrome
Metabolic disease
?
Colorectal cancer
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• Gut and vaginal microbiota of the elderly display
communities of reduced diversity and increased
inter-personal variability.
• Menopause as opportunity to identify the factors
involved in maintaining homeostasis and the
relationship to aspects of inflamm-aging
and immunosenescence in elderly
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5) La flora lattobacillare vaginale in
menopausa …
• Ha un reservoir a livello
intestinale
• Si riduce in varieta` di specie
• E` ridotta nei casi di GSM
• Tutte le precedenti
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MICROBIOTA
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✔
✔
Microbiota in Menopause
• Menopausal microbiota
• Vagina
• Gut
• Mouth
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✔
• 2000 B.C.E. - Here, eat this root
• 1000 A.D. - That root is heathen. Here, say the prayer
• 1850 - The prayer is superstition. Here , drink the
potion
• 1920 - That potion is snake oil. Here, swallow the pill
• 1945 – That pill is ineffective. Here, take the penicillin
• 1955 – Oops…bugs got resistant. Here, take this
tetracycline
• 1957-2003 - …more oops….Here, take this more
powerful antibiotic
• 2015 – The bugs have won ! Here , eat this root or
BALANCE YOUR MICROBIOTA
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“Quelli
che
s’innamoran
di
pratica
sanza
scienzia son come
‘l nocchier ch’entra
in navilio sanza
timone o bussola,
che
mai
ha
certezza dove si
vada”
Leonardo da Vinci
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