title: Comparison of the vaginal microbial communities in women with recurrent genital HSV receiving acyclovir intravaginal rings.
abstract: Vaginally administered antiviral agents may reduce the risk of HIV and HSV acquisition. Delivery of these drugs using intravaginal rings (IVRs) holds the potential benefits of improving adherence and decreasing systemic exposure, while maintaining steady-state drug levels in the vaginal tract. Elucidating how IVRs interact with the vaginal microbiome constitutes a critical step in evaluating the safety of these devices, as shifts the vaginal microbiome have been linked with several disease states. To date, clinical IVR trials have relied on culture-dependent methods that omit the high diversity of unculturable microbial population. Longitudinal, culture-independent characterization of the microbiota in vaginal samples from 6 women with recurrent genital HSV who used an acyclovir IVR was carried out and compared to the communities developing in biofilms on the IVR surface. The analysis utilized Illumina MiSeq sequence datasets generated from bar-coded amplicons of 16S rRNA gene fragments. Specific taxa in the vaginal communities of the study participants were found to be associated with the duration of recurrent genital HSV status and the number of HSV outbreaks. Taxonomic comparison of the vaginal and IVR biofilm communities did not reveal any significant differences, suggesting that the IVRs were not systematically enriched with members of the vaginal microbiome. Device usage did not alter the participants' vaginal microbial communities, within the confines of the current study design. Rigorous, molecular analysis of the effects of intravaginal devices on the corresponding microbial communities shows promise for integration with traditional approaches in the clinical evaluation of candidate products.
authors.affiliation: Department of Chemistry and Biochemistry, University of Colorado at Boulder, Boulder, CO, USA.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Ursell
authors.affiliation: Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Blvd., Pasadena, CA, USA.
authors.forename: Manjula
authors.initials: M
authors.lastname: Gunawardana
authors.affiliation: Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Blvd., Pasadena, CA, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Blvd., Pasadena, CA, USA.
authors.forename: Madeline
authors.initials: M
authors.lastname: Mullen
authors.affiliation: Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Blvd., Pasadena, CA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Moss
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Herold
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, USA.
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Keller
authors.affiliation: Biofrontiers Institute, University of Colorado at Boulder, Boulder, CO, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: McDonald
authors.affiliation: Biofrontiers Institute, University of Colorado at Boulder, Boulder, CO, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: González
authors.affiliation: Department of Chemistry and Biochemistry, University of Colorado at Boulder, Boulder, CO, USA; Department of Computer Science, University of Colorado at Boulder, Boulder, CO, USA; Howard Hughes Medical Institute, Boulder, CO, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Knight
authors.affiliation: Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Blvd., Pasadena, CA, USA. Electronic address: m.baum@oak-crest.org.
authors.forename: Marc M
authors.initials: MM
authors.lastname: Baum
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000282:Administration, Intravaginal; D001419:Bacteria / Q000145:classification* / Q000235:genetics*; D058448:Biota; D003274:Contraceptive Devices, Female / Q000382:microbiology*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D006558:Herpes Genitalis / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012008:Recurrence; D017422:Sequence Analysis, DNA; D014621:Vagina / Q000382:microbiology*
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S; D000212:Acyclovir
keywords: 16S rRNA gene sequencing; Anti-HSV-2; Biofilm; Intravaginal ring; Microbicide safety; Vaginal microbiota