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Rebecca Brotman: Toward Interventions for the Vaginal Microbiome

Rebecca Brotman: Toward Interventions for the Vaginal Microbiome
Assistant Professor, Institute for Genome Sciences at the University of Maryland School of Medicine
Recommended by Jacques Ravel and Claire Fraser-Liggett, University of Maryland

Brotman.jpgRebecca Brotman is an epidemiologist and infectious disease expert by training, and it's with that mindset that she approaches studying the human vaginal microbiome. The vaginal microbiome has been implicated in health and disease, protecting against sexually transmitted diseases or affecting risk of contracting them, including HIV. It has also been linked to obstetrical outcomes such as preterm birth.

"Ultimately we would like to be able to intervene on the vaginal microbiota to provide more protection for women, but in order to get there, first we have to determine what's there," Brotman said.

She and her colleagues at Maryland have been examining the vaginal microbiome to first determine what bacteria are typically there as well as following how the microbiome changes over time as women age and how it changes in response to certain behaviors, including smoking, lubricant use, and other sexual behaviors. Once they establish that baseline of knowledge, Brotman said they can start investigating ways to intervene.

In particular, Brotman is focused on vaginal dysbiosis, which is marked by low levels of Lactobacillus in the vaginal microbiome, and places women at higher risk for reproductive tract infections.

Many people, she noted, want to jump right to interventions, but she added that there have been a number of studies examining probiotics, and they don't appear to always be successful.

"We need to stand back and look at the data and figure out what's there, how it changes over time, and a rational approach to intervening on the microbiome," Brotman said. She added that they are working toward interventions, but "we're just not quite there yet."

Paper of note

Brotman has been part of work published in Proceedings of the National Academy of Sciences and Science Translational Medicine reporting on the vaginal microbiome and how it changes over time, but earlier this year, she and her colleagues also publish a paper in Menopause that looked at the vaginal microbiome in the context of disease.

For that study, they examined the vaginal microbiota of premenopausal, perimenopausal, and postmenopausal women, and found that a specific bacterial state — marked by low levels of Lactobacillus — was associated with vulvovaginal atrophy, which is common in women approaching menopause.

"I think that's a nice representation of the vaginal microbiome and its association with a very important clinical outcome, " Brotman said.

Looking ahead

In the next five years or so, Brotman hopes that there will be a better understanding of how to intervene on and affect the vaginal microbiome to improve women's health. "I think that it'll include both behavioral interventions like, for example, quitting smoking or using a different type of lubricant or using a different condom type or all the way to — I don't know whether in five years we'll have a probiotic, but I certainly hope that by then we'll be well on the way to understanding other biological ways to affect the microbiome," she said.

And the Nobel goes to…

If Brotman were to win the Nobel Prize, she would like it to be for work on preventing and curing bacterial vaginosis and the dysbiosis of the vaginal microbiome. That, she added, could be "a great public health success" because it has the possibility to limit the spread of HIV.

Photo by Matt Mendelsohn