Insights into the assembly of the neovaginal microbiota in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients

Na Chen, Lilan Hao, Zhe Zhang, Chenglu Qin, Zhuye Jie, Hongxin Pan, Jiali Duan, Xincheng Huang, Yunhong Zhang, Hongqin Gao, Ruike Lu, Tianshu Sun, Hua Yang, Jinqiu Shi, Maolian Liang, Jianbin Guo, Qianqian Gao, Xiaoyue Zhao, Zhiyuan Dou, Liang Xiao, Shaoqiao Zhang, Xin Jin, Xun Xu, Huanming Yang, Jian Wang, Huijue Jia, Tao Zhang (), Karsten Kristiansen (), Chen Chen () and Lan Zhu ()
Additional contact information
Na Chen: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Lilan Hao: BGI-Research
Zhe Zhang: BGI-Research
Chenglu Qin: The 3rd Affiliated Hospital of Shenzhen University, Luohu hospital
Zhuye Jie: BGI-Research
Hongxin Pan: Southern University of Science and Technology Hospital
Jiali Duan: 4+4 Medical Doctor Program, No.9 Dongdansantiao
Xincheng Huang: BGI-Research
Yunhong Zhang: Social Affairs Bureau of Suzhou National New and Hi-tech Industrial Development Zone
Hongqin Gao: Suzhou National New and Hi-tech Industrial Development Zone Center for Maternal and Child Health and Family Planning Service
Ruike Lu: Suzhou National New and Hi-tech Industrial Development Zone Center for Maternal and Child Health and Family Planning Service
Tianshu Sun: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Hua Yang: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Jinqiu Shi: The 3rd Affiliated Hospital of Shenzhen University, Luohu hospital
Maolian Liang: The 3rd Affiliated Hospital of Shenzhen University, Luohu hospital
Jianbin Guo: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Qianqian Gao: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Xiaoyue Zhao: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Zhiyuan Dou: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan
Liang Xiao: BGI-Research
Shaoqiao Zhang: BGI Research
Xin Jin: BGI-Research
Xun Xu: BGI-Research
Huanming Yang: BGI-Research
Jian Wang: BGI-Research
Huijue Jia: BGI-Research
Tao Zhang: BGI Research
Karsten Kristiansen: BGI-Research
Chen Chen: BGI-Research
Lan Zhu: Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan

Nature Communications, 2024, vol. 15, issue 1, 1-15

Abstract: Abstract Neovaginas are surgically constructed to correct uterovaginal agenesis in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or as part of gender-affirming surgery for transfeminine individuals. Understanding the assembly of the neovaginal microbiota is crucial for guiding its management. To address this, we conducted a longitudinal study on MRKH patients following laparoscopic peritoneal vaginoplasty. Our findings reveal that the early microbial assemblage exhibited stochastic characteristics, accompanied with a notable bloom of Enterococcus faecalis and genital Mycoplasmas. While both the pre-surgery dimple microbiota and the fecal microbiota constituted the primary species pool, the neovaginal microbiota developed into a microbiota that resembled that of a normal vagina at 6–12 months post-surgery, albeit with a bacterial vaginosis (BV)-like structure. By 2–4 years post-surgery, the neovaginal microbiota had further evolved into a structure closely resembling with the homeostatic pre-surgery dimple microbiota. This concords with the development of the squamous epithelium in the neovagina and highlights the pivotal roles of progressive selective forces imposed by the evolving neovaginal environment and the colonization tropism of vaginal species. Notably, we observed that strains of Lactobacillus crispatus colonizing the neovagina primarily originated from the dimple. Since L. crispatus is generally associated with vaginal health, this finding suggests potential avenues for future research to promote its colonization.

Date: 2024
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DOI: 10.1038/s41467-024-52102-1

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