Patent Application
20190054128
The present invention is directed to the direct topical application of beneficial or probiotic bacteria to the vaginal niche for maintenance of a healthy vaginal microbiota and to help restore an unbalanced vaginal microbiota. This restoration of a healthy microbiota falls under the term probiotherapy, defined as the use of beneficial micro-organisms or probiotics to restore a healthy microbiota at a site where microbial dysbiosis occurs. The application is based on the use of selected Lactobacillus strains as anti-pathogenic agents, in particular L. pentosus and/or L. plantarum, against common vaginal pathogens, whereby produced acids such as lactic acid are important antimicrobial factors.
In contrast to the microbiota of the gastro-intestinal tract, the composition of the urogenital microbiota is much less complex. This microbiota develops after birth and is originating from the vaginal microbiota of the mother, the environment and migrating microbiota from the skin and lower gastro-intestinal tract. The vaginal microbiota lives in mutualism with its host and has an important role in health and disease. Although the microbial composition in healthy women can differ, it is typically dominated by one of four Lactobacillus species (L. crispatus, L. iners, L. gasseri, L. jensenii) that are commonly found in healthy individuals. However, in some cases their microbiota is dominated by several facultative anaerobic lactic acid bacteria, without a significant presence of lactobacilli. Therefore, rather than the specific bacterial species, the functional capacity of the microbiota members, among which is the production of lactic acid, plays a key role in maintaining a healthy state.
Several vaginal discomforts are a consequence of a disturbed microbial composition. Infections with Candida albicans, bacterial vaginosis (BV) and aerobic vaginitis (AV) are the most common encountered problems. These diseases/infections/imbalances are characterized by a lowering of the total amount of lactobacilli and overgrowth of yeast (candidose), facultative anaerobic bacteria (BV) and aerobic gram-negative bacteria (AV), respectively. Under normal circumstances, the fungus Candida albicans lives as commensal in the gastrointestinal and the urogenital tract. However, when the normal microbiota is disturbed, the epithelial barrier is breached or when the immune system is malfunctioning, Candida albicans can alter from a commensal to a pathogen. This can cause a broad spectrum of diseases including skin, mucosal and systemic infections. Over the recent years, this organism has become one of the most common causes of hospital-acquired infections. Many of these infections are caused by biofilm formation on the surfaces of medical devices, such as implants. The most important characteristic of Candida biofilm cells is their remarkable resistance to antifungal drugs. Often, the only solution is the mechanical removal of the implant, which is associated with increased procedural morbidity and health care expenditures. Therefore the development of new antifungal agents, in addition to now antibacterial agents, to treat these infections is of great interest.
The production of lactic acid in combination with keeping a low pH seems to give protection against aforementioned infections and dysbiotic conditions and lactic acid seems to be active against bacterial, fungal and even viral pathogens. It is for this reason that lactobacilli are considered to be important in the homeostasis of the dynamical vaginal ecosystem. Potential health promoting mechanisms of lactobacilli are i) to preserve a low vaginal pH (<4.5), mainly by production of lactic acid; ii) production of antimicrobial compounds and competitive exclusion of pathogens; iii) modulation of immune response and iv) strengthening of the epithelial barrier.
Hence, it was an object of the present invention to provide a solution for subjects suffering from vaginal discomforts due to an aberrant microbial balance in the vagina. Thereto, it was found that the topical vaginal use of L. pentosus species is very effective in restoring and/or maintaining a healthy microbiota in the vagina, and is thus very suitable in relieving vaginal discomforts in subjects in need thereof.
Oral formulations comprising Lactobacillus strains have been used before in the treatment of vaginal disorders or for restoring and/or maintaining a healthy microbiota in the vagina. However, oral administration versus direct topical administration are different administration routes and each have a completely different underlying mechanism. In oral administration, in particular a beneficial effect on the general health via immuno-stimulation is intended, whereas by direct vaginal administration, competition with ‘unwanted’ microorganisms occur.
Topical vaginal administration of compositions comprising live Lactobacillus strains, were found to be useful in the treatment of vaginal infections, such as for example mentioned in WO2012101550, WO15022297, WO03033681, WO0113956, WO20040350726. However, these do not address the use thereof in the restoration and/or maintenance of a healthy vaginal microbiota.
A very recent publication by Tomusiak et al. indicates the relevance of the current invention (Tomusiak et al., 2015). In particular, Tomusiak et al. found that the vaginal administration of Lactobacillus strains sustainably restores the healthy vaginal microbiota. Further to the findings of Tomusiak that were based on L. fermentum, L. plantarum and L. gasseri species, we have found that L. pentosus is particularly suitable in the context of the present invention. Furthermore, Tomusiak used an intravaginal capsule to formulate the Lactobacillus species, whereas we found that the formulation in a non-solid composition is much more effective, due to a better spreading capacity along the vaginal epithelial cells.
In a first aspect, the present invention provides a topical vaginal composition comprising one or more live Lactobacillus species; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
In a further aspect, the present invention provides a live Lactobacillus species for use in restoring and/or maintaining a healthy female microbiota, by topical vaginal route, said Lactobacillus species being L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
In yet a further aspect, the present invention provides the use of one or more live Lactobacillus species, in the preparation of a topical vaginal composition for restoring and/or maintaining a healthy female microbiota; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
The present invention also provides a method for restoring and/or maintaining a healthy female microbiota; comprising at least one step of administering by topical vaginal route, to an individual, an effective amount of one or more live Lactobacillus species; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
In yet another aspect, the present invention provides a composition comprising one or more live Lactobacillus species for use in restoring and/or maintaining a healthy female microbiota, by topical vaginal route, said Lactobacillus species being selected from the list comprising L. pentosus and L. plantarum, more in particular L. pentosus; even more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene and a L. plantarum strain having at least 97% sequence similarity with SEQ ID No 4 in its 16S rRNA gene.
The present invention further provides a Lactobacillus strain selected from the list comprising L. pentosus YUN-V1.0 deposited under accession number LMG P-29455 (deposited at BCCM on Mar. 9 2016); and L. plantarum YUN-V2.0 deposited under accession number LMG P-29456 (deposited at BCCM on Mar. 9 2016).
In a particular aspect, the present invention provides a composition comprising one or more Lactobacillus strains as defined herein above.
In a particular embodiment, the composition of the present invention is a topical vaginal composition, more in particular in the form of a gel, cream, foam, lotion or ointment.
In another particular embodiment, the present invention provides the Lactobacillus strain as defined herein above or the compositions as defined herein above; for use in restoring and/or maintaining a healthy female microbiota, by topical vaginal route.
In a particular aspect, the present invention provides a topical vaginal use of one or more live Lactobacillus species in probiotherapy; wherein said Lactobacillus species are selected from the list comprising L. pentosus and L. plantarum; more in particular, said said probiotherapy consists of restoring and/or maintaining a healthy female microbiota in a subject in need thereof.
In another particular embodiment, said Lactobacillus species in the (topical vaginal) uses, methods and compositions as disclosed herein, is a Lactobacillus strain selected from the list comprising L. pentosus YUN-V1.0 deposited under accession number LMG P-29455 (deposited at BCCM on Mar. 9 2016); and L. plantarum YUN-V2.0 deposited under accession number LMG P-29456 (deposited at BCCM on Mar. 9 2016).
With specific reference now to the figures, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of the different embodiments of the present invention only. They are presented in the cause of providing what is believed to be the most useful and readily description of the principles and conceptual aspects of the invention. In this regard no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention. The description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.
B) Detection of the exogeneously added Lactobacillus strains at visits 2 and 3 when the probiotic cream was used.
B) Detection of the exogeneously added Lactobacillus strains at visits 2 and 3 when the probiotic cream was used.
The present invention is based on the discovery of specific Lactobacillus strains that can compete with the growth of Candida albicans and bacteria that are linked with bacterial vaginosis and aerobic vaginitis. These selected strains are herein generally termed “YUN” strains and are capable of competing with vaginal pathogens and thereby restore a healthy vaginal microbiota. This restoration of a healthy microbiota falls under the term probiotherapy, defined as the use of beneficial micro-organisms or probiotics to restore a healthy microbiota at a site where microbial dysbiosis occurs.
Hence, in a first aspect, the present invention provides a topical vaginal composition comprising one or more live Lactobacillus species; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
Said composition according to the present invention may comprise further Lactobacillus species such as for example selected from the non-limiting list comprising L. plantarum, L. gasseri, L. crispatus, L. acidophilus, L. jensenii, L. fermentum, L. rhamnosus.
In the context of the present invention, the term “topical” is meant to be the local delivery at a specified location of the body, in particular the application to a particular place on or in the body. In particular, it includes the application to mucous membranes via non-solid formulations such as creams, foams, gels, lotions or ointments. The term “topical” is not meant to include the delivery in the form of solid preparations such as capsules, tablets, . . . .
Hence, the term “topical vaginal” is meant to include the local delivery using non-solid formulations directly in the vaginal tract of the body. Preferably, the compositions according to the present invention are applied over a large area of the mucous membranes of the vagina in order to be most effective.
In the context of the present invention the term “live Lactobacillus species” is meant to be viable Lactobacillus species, and is not meant to be fragments, culture supernatants, or killed forms thereof.
In a further aspect, the present invention provides a live Lactobacillus species for use in probiotherapy, by topical vaginal route, said Lactobacillus species being L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene. As already defined herein above, said probiotherapy is meant to be the restoration and/or maintainance of a healthy female microbiota in a subject in need thereof.
Subjects that may benefit from such probiotherapy are for example female patients with a disturbed vaginal microbiota possibly due to a vaginal yeast infection, bacterial vaginosis, aerobic vaginitis and/or any dysbiosis caused by overgrowth of other micro-organisms than lactobacilli.
Hence, in a further aspect, the present invention provides the use of one or more live Lactobacillus species, in the preparation of a topical vaginal composition for restoring and/or maintaining a healthy female microbiota; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
The present invention also provides a method for restoring and/or maintaining a healthy female microbiota; comprising at least one step of administering by topical vaginal route, to an individual, an effective amount of one or more live Lactobacillus species; wherein at least one of said Lactobacillus species is L. pentosus; more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID No 1 in its 16S rRNA gene.
In yet another aspect, the present invention provides a composition comprising one or more live Lactobacillus species for use in restoring and/or maintaining a healthy female microbiota, by topical vaginal route, said Lactobacillus species being selected from the list comprising L. pentosus and L. plantarum, more in particular L. pentosus; even more in particular a L. pentosus strain having at least 97% sequence similarity with SEQ ID N° 1 in its 16S rRNA gene and a L. plantarum strain having at least 97% sequence similarity with SEQ ID No 4 in its 16S rRNA gene.
The present invention further provides a Lactobacillus strain selected from the list comprising L. pentosus YUN-V1.0 deposited under accession number LMG P-29455 (deposited at BCCM on Mar. 9 2016); and L. plantarum YUN-V2.0 deposited under accession number LMG P-29456 (deposited at BCCM on Mar. 9 2016).
The microbiological deposits mentioned herein, have been made with the BCCM/LMG Bacteria collection (“Belgian co-ordinated collections of micro-organism”) with correspondence address: Laboratorium voor Microbiologie, Universiteit Gent, K. L. Ledeganckstraat 35-9000 Gent, Belgium
Lactobacillus pentosus YUN-V1.0 is a single colony isolate obtained in our lab after subculturing of a strain that was originally a vaginal isolate of healthy woman. The 16S rRNA gene sequence (SEQ ID No 1) for strain L. pentosus YUN-V1.0 was determined by PCR using primers 8F (5′-AGAGTTTGATCCTGGCTCAG-3′-SEQ ID No 2) and 1525R (5′-AAGGAGGTGATCCAGCCGCA-3′-SEQ ID No 3).
YUN-V2.0 and YUN-V3.0 are single colony isolates obtained in our lab after subculturing of Lactobacillus plantarum strains that were originally isolated from human saliva and a maize silage respectively. The 16S rRNA gene sequence (SEQ ID No 4) for strain L. plantarum YUN-V2.0 was determined by PCR using primers 8F (5′-AGAGTTTGATCCTGGCTCAG-3′-SEQ ID No 2) and 1525R (5′-AAGGAGGTGATCCAGCCGCA-3′-SEQ ID No 3).
These particular “YUN” strains can either be used as such, or are preferably formulated in a composition comprising such strains. Said compositions are topical vaginal compositions more in particular in the form of non-solid formulations such as creams, foams, gels, lotions or ointments.
In particular, the present invention provides the above defined “YUN” strains for use in probiotherapy, i.e. for restoring and/or maintaining a healthy female microbiota, by topical vaginal route.
In yet a further aspect, the present invention provides a topical vaginal use of one or more live Lactobacillus species in probiotherapy; wherein said Lactobacillus species are selected from the list comprising L. pentosus and L. plantarum; more in particular, said probiotherapy consists of restoring and/or maintaining a healthy female microbiota in a subject in need thereof.
In a specific embodiment, the Lactobacillus species in the (topical vaginal) uses, methods and compositions as disclosed herein, is a Lactobacillus strain selected from the list comprising L. pentosus YUN-V1.0 deposited under accession number LMG P-29455 (deposited at BCCM on Mar. 9 2016); and L. plantarum YUN-V2.0 deposited under accession number LMG P-29456 (deposited at BCCM on Mar. 9 2016).
Lactobacillus strains (Table 1) were grown at 37° C. in de Man, Rogosa and Sharpe (MRS) medium (Carl Roth). All bacteria were grown in non-shaking conditions and inoculated from glycerol stocks (−80° C.). Solid media contained 1.5% (w/v) agar.
Lactobacillus casei
Lactobacillus casei
Lactobacillus casei
Lactobacillus
pentosus
Lactobacillus
plantarum
plantarum ATCC8014 or
Lactobacillus reuteri
Lactobacillus
rhamnosus
Lactobacillus
rhamnosus
Lactobacillus
helveticus
Lactobacillus
plantarum
Lactobacillus
plantarum
Lactobacillus
paracasei
Lactobacillus
plantarum
Lactobacillus
pentosus
Candida albicans
To obtain spent culture supernatant (SCS) containing the secreted active antimicrobial products, growth medium specific for each species was inoculated from a preculture and incubated for 24 h. SCS was obtained by centrifugation for 30 min. at 6797 g (8000 rpm) at 4° C. Afterwards, the SCS was filter sterilized (0.20 μm cellulose acetate, VWR).
The antimicrobial activity of the selected bacteria was explored by standard antimicrobial tests with some minor modifications. For the streak inoculation assay, lactobacilli were streak inoculated from a colony on a starter plate (MRS) on a test plate (medium of pathogen) and incubated at 37° C. for 54 h. Then, the pathogens were streak inoculated from a colony on a starter plate on the test plates in 3 repetitions. The plates were incubated at 37° C. for 24 h and the inhibition zone was measured as described previously (Hutt et al. 2006). In addition, the antimicrobial activity of the selected bacteria were explored by spot assay (Schillinger and Lücke 1989). Briefly, 1-3 μL of each culture was spotted on an agar plate. These plates were incubated for 24 h up to 72 h depending on the strain. Next, an overnight culture of the pathogen was diluted into 7 mL of soft agar of the medium of the pathogen and poured over the plates with the spots of the selected strains. The plates were incubated overnight at 37° C., after which the inhibition zones were measured. A spot of miconazole and/or 0.1% hexetidine was added to the spot plate as positive control before the soft agar was poured.
In addition, the antimicrobial activity of spent culture supernatant (SCS) was investigated with a protocol as previously described for the competition assays between lactobacilli and gastro-intestinal pathogens (Coconnier et al. 1997). Miconazole was used as a positive control. Sterile growth medium was used as a negative control.
The time course analysis was performed as described previously (De Keersmaecker et al. 2006) with minor modifications. Briefly, an overnight culture of C. albicans, Gardnerella vaginalis (BV) or Streptococcus agalactiae (AV) was added to the wells of a microplate filled with 50-80% the proper medium supplemented with 50-5% SCS of lactobacilli. MRS at pH 4,3 and miconazole (0.02 μg/ml final concentration) were used as a negative and a positive control, respectively. Bacteria were grown and the optical density (OD) was measured at 590 nm each 30 min during 3 days using a Synergy HTX multi-mode reader (Biotek). Each test was measured at least in triplicate and the average OD was calculated. The antimicrobial activity was expressed as the relative optical density reached after 24 h (stationary phase) compared to the negative controls.
As a first indicator of safety, the ability of the Lactobacillus strains to elicit a pro-inflammatory response in the form of an upregulation of interleukin 8 in the VK2/E6E7 cell line, an immortalized vaginal epithelium cell line, was tested. VK2/E6E7 cells were grown to a confluent monolayer and exposed to 1.5. 107CFU's or miconazole (0.2 μg/ml final concentration) for approximately 90 minutes, after which RNA was extracted. RT-qPCR was used to determine relative expression levels of IL8, compared to those of reference genes actinβ (ACTb) and glyceraldehyde 3-phosphate dehydrogenase (GAPDH).
Proof-of-Concept Human Clinical Trial in Patients with Vaginal Candidose
A proof-of-concept clinical trial was performed on 20 patients with vaginal candidose. Patients were between 18-45 years and had severe inflammation (vaginitis). The aim of this proof-of-concept trial was to assess the impact of a vaginal silicon-based gel containing 10% probiotic powder (fit-for-purpose vaginal anhydrous system: containing +−10-11 colony forming units (CFU) of L. pentosus YUN-V1.0 and +−10-11 CFU of L. plantarum YUN-V2.0 per application of 2-2.5 ml of an anhydrous system) on the vaginal microbiota and on the Candida infection. The formulation was produced by blending the bacterial powder under vacuum in the silicon-based gel and filled in aluminum-coated tubes of 30 ml. Patients were asked to daily apply the cream intravaginally using an applicator for 10 days. The patients were seen by a gynaecologist at day 0 (before the therapy), day 1, day 5 and day 10. A vaginal washing sample was taken at each visit. Bacterial DNA was isolated from these samples by the commercial MoBio Powersoil kit (cfr. Human Microbiome Project). Isolated DNA was analysed via 16S rRNA amplicon sequencing with MiSeq Illumina and a bio-informatical analysis was performed. The same washing samples were also used to determine Candida albicans counts by selective agar plating (Sabouraud Dextrose agar or similar). Moreover, a clinical scoring was performed at each visit.
Antibiotic sensitivity was evaluated using the Kirby-Bauer disc diffusion test. In short, antibiotics were spotted on paper discs and the bacterial inhibition zone was measured on agar plates. The antibiotics tested were erythromycin, normocin, tetracyclin, ampicillin and clindamycin at relevant concentrations.
Possible beneficial or probiotic strains were characterized in terms of growth characteristics, lactate production (based on D- and L-lactic acid production) and ability of lowering of the pH of the medium. These characteristics are expected to be important in maintenance and/or restoring the healthy vaginal microbiota. These data show that Lactobacillus pentosus YUN-V1.0 and L. plantarum YUN-V2.0 and YUN-V3.0 produce the highest amount of lactic acid, in particular due to a significant increase in D-Lactic Acid production (see
In a next phase, the beneficial or probiotic bacteria were screened for their antipathogenic effect against Candida albicans. The results of a radial diffusion test are shown in table 2. Spent culture supernatant from L. pentosus YUN-V1.0 was demonstrated to be superior in inhibiting Candida albicans growth. L. plantarum YUN-V2.0 and YUN-V3.0 showed inhibition to a smaller extent but still better or similar than most of the other Lactobacillus strains.
Candida
Lactobacillus casei ATCC334
Lactobacillus casei Immunitas
Lactobacillus casei Shirota
Lactobacillus pentosus YUN-V1.0
Lactobacillus plantarum LMG1284 or ATCC8014
Lactobacillus reuteri RC-14
Lactobacillus rhamnosus GG (=LGG)
Lactobacillus rhamnosus GR-1
Lactobacillus helveticus
Lactobacillus plantarum YUN-V2.0
Lactobacillus plantarum YUN-V3.0
Lactobacillus paracasei subsp. paracasei
A spot-based antipathogenic assay was also performed to investigate the anti-pathogenic activity of the selected live Lactobacillus species against Candida albicans. The selected strains all inhibited growth of Candida to some extent but the most effective strains were L. plantarum YUN-V2.0 and L. plantarum YUN-V3.0 (see table 3).
Candida
Lactobacillus pentosus YUN-V1.0
Lactobacillus plantarum LMG1284 of
Lactobacillus rhamnosus GG (=LGG)
Lactobacillus rhamnosus GR-1
Lactobacillus plantarum YUN-V2.0
Lactobacillus plantarum YUN-V3.0
Lactobacillus plantarum
Lactobacillus pentosus LMG 8041
Thirdly, time course experiments were performed analyzing the antimicrobial activity of SCSs of the selected strains against Candida. Again, SCSs of all tested strains inhibited the growth of Candida to some extent, while most effective strains were L. plantarum YUN-V1.0, L. plantarum YUN-V2.0 and L. plantarum YUN-V3.0 (see
As an indicator of safety, the ability of the strains to induce the pro-inflammatory chemokine interleukin 8, was analyzed. Some strains showed a relatively small increase in expression, but as desired none of the tested strains elicited a strong interleukin 8 response. However, a clear IL-8 upregulation was observed for L. reuteri RC-14 (
It was observed by microscopy that a larger number of cells had died during the treatment, compared to the negative control.
Case Studies from Proof-of-Concept Human Clinical Trial in Patients with Vaginal Candidose
The vaginal microbiome of patients with acute vaginal candidose in a proof-of-concept clinical trial was analyzed at different time points. In general, two different groups could be observed at the start of the trial: i) one group of patients where the endogenous vaginal lactobacilli are still present but where these lactobacilli were not able to protect against the yeast infection and ii) a second group of patients where the bacterial microbiome is disturbed and a loss of lactobacilli is observed. In these patients, other non-lactobacilli, e.g. Atopobium spp. and Gardnerella spp. show up in addition to the yeast infection.
In what follows, two case studies are highlighted of patients which were enrolled in the study and were cured by using the vaginal probiotic gel containing L. pentosus YUN-V1.0 and L. plantarum YUN-V2.0.
In
In
The selected bacteria were also tested for their antibiotic susceptibility as to prevent spreading of antibiotic resistance genes. All lactobacilli were susceptible to erythromycin, normocin, tetracyclin, ampicillin and clindamycin, except for L. plantarum 5057, which was susceptible to tetracyclin. For this reason, strain L. plantarum 5057 was found not to be suitable to use as a strain for probiotherapy.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2016/5201 | Mar 2016 | BE | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2017/056691 | 3/21/2017 | WO | 00 |
