We report the results of a first exploratory study testing the use of vaginal microbiome transplantation (VMT) from healthy donors as a therapeutic alternative for patients suffering from symptomatic, intractable and recurrent bacterial vaginosis (ClinicalTrials.gov NCT02236429). In our case series, five patients were treated, and in four of them VMT was associated with full long-term remission until the end of follow-up at 5–21 months after VMT, defined as marked improvement of symptoms, Amsel criteria, microscopic vaginal fluid appearance and reconstitution of a Lactobacillus-dominated vaginal microbiome. One patient presented with incomplete remission in clinical and laboratory features. No adverse effects were observed in any of the five women. Notably, remission in three patients necessitated repeated VMT, including a donor change in one patient, to elicit a long-standing clinical response. The therapeutic efficacy of VMT in women with intractable and recurrent bacterial vaginosis should be further determined in randomized, placebo-controlled clinical trials.
Bibliographical noteFunding Information:
We thank the members of the Hadassah-Hebrew University Medical Center Department of Obstetrics and Gynecology, the Elinav lab at the Weizmann Institute of Science and members of the DKFZ Cancer–Microbiome division for insightful discussions. We thank S.M. Cohen for expert editing. All cartoons were created, under a license, using BioRender software. The study was supported by a grant from the Joint Research Fund of the Hebrew University of Jerusalem and Hadassah Medical Center. H.S. is the incumbent of the V.R. Schwartz Research Fellow Chair. E.E. is supported by Yael and Rami Ungar, the Leona M. and Harry B. Helmsley Charitable Trust, the Adelis Foundation, the Pearl Welinsky Merlo Scientific Progress Research Fund, the Lawrence and Sandra Post Family Foundation, the Daniel Morris Trust, the Park Avenue Charitable Fund, the Hanna and Dr. Ludwik Wallach Cancer Research Fund, the Howard and Nancy Marks Charitable Fund, Aliza Moussaieff, the estate of Malka Moskowitz, the estate of Myron H. Ackerman, the estate of Bernard Bishin for the WIS-Clalit Program, Donald and Susan Schwarz, and grants funded by the European Research Council, the Israel Science Foundation, the Israel Ministry of Science and Technology, the Israel Ministry of Health, the Helmholtz Foundation, the Else Kroener Fresenius Foundation, the Garvan Institute, the European Crohn’s and Colitis Organization, the Deutsch-Israelische Projektkooperation and the Wellcome Trust. E.E. is the incumbent of the Sir Marc and Lady Tania Feldmann Professorial Chair, a senior fellow at the Canadian Institute of Advanced Research and an international scholar at the Bill & Melinda Gates Foundation and the Howard Hughes Medical Institute.
© 2019, The Author(s), under exclusive licence to Springer Nature America, Inc.