title: Differential expression of lactic acid isomers, extracellular matrix metalloproteinase inducer, and matrix metalloproteinase-8 in vaginal fluid from women with vaginal disorders.
abstract: OBJECTIVE
  Do metabolites in vaginal samples vary between women with different vaginal disorders.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Campinas, Brazil.
  
  
  METHODS
  Seventy-seven women (39.9%) with no vaginal disorder, 52 women (26.9%) with vulvovaginal candidiasis (VVC), 43 women (22.3%) with bacterial vaginosis (BV), and 21 women (10.9%) with cytolytic vaginosis (CTV).
  
  
  METHODS
  Concentrations of D- and L-lactic acid, extracellular matrix metalloproteinase inducer (EMMPRIN), and matrix metalloproteinase-8 (MMP-8), and the influence of Candida albicans on EMMPRIN production by cultured vaginal epithelial cells, were determined by enzyme-linked immunosorbent assay (ELISA). Associations were determined by the Mann-Whitney U-test and by Spearman's rank correlation test.
  
  
  METHODS
  Metabolite levels and their correlation with diagnoses.
  
  
  RESULTS
  Vaginal concentrations of D- and L-lactic acid were reduced from control levels in BV (P < 0.0001); L-lactic acid levels were elevated in CTV (P = 0.0116). EMMPRIN and MMP-8 concentrations were elevated in VVC (P < 0.0001). EMMPRIN and L-lactic acid concentrations (P ≤ 0.008), but not EMMPRIN and D-lactic acid, were correlated in all groups. EMMPRIN also increased in proportion with the ratio of L- to D-lactic acid in controls and in women with BV (P ≤ 0.009). Concentrations of EMMPRIN and MMP-8 were correlated in controls and women with VVC (P ≤ 0.0002). Candida albicans induced EMMPRIN release from vaginal epithelial cells.
  
  
  CONCLUSIONS
  Vaginal secretions from women with BV are deficient in D- and L-lactic acid, women with VVC have elevated EMMPRIN and MMP-8 levels, and women with CTV have elevated L-lactic acid levels. These deviations may contribute to the clinical signs, symptoms, and sequelae that are characteristic of these disorders.
authors.affiliation: Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.|Department of Gynecology and Obstetrics, University of Campinas, Campinas, Sao Paulo, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Beghini
authors.affiliation: Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.|Department of Gynecology and Obstetrics, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: I M
authors.initials: IM
authors.lastname: Linhares
authors.affiliation: Department of Gynecology and Obstetrics, University of Campinas, Campinas, Sao Paulo, Brazil.
authors.forename: P C
authors.initials: PC
authors.lastname: Giraldo
authors.affiliation: Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Ledger
authors.affiliation: Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Witkin
mesh_terms: D000328:Adult; D051926:Basigin / Q000378:metabolism*; D001826:Body Fluids / Q000378:metabolism; D001938:Brazil; D002181:Candidiasis, Vulvovaginal / Q000378:metabolism* / Q000382:microbiology; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D004847:Epithelial Cells; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D020784:Matrix Metalloproteinase 8 / Q000378:metabolism*; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000378:metabolism* / Q000382:microbiology
chemical_list: D051926:Basigin; D019344:Lactic Acid; D020784:Matrix Metalloproteinase 8
keywords: Bacterial vaginosis; cytolytic vaginosis; d-lactic acid; extracellular matrix metalloproteinase inducer; l-lactic acid; matrix metalloproteinase-8; vulvovaginal candidiasis