Infectious Diseases and Reproductive Health

At the American Society for Microbiology Microbe 2017 New Orleans meeting, Contagion® spoke with David Aronoff, MD, FIDSA, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine, and ASM Microbe 2017 Vice-Chair, about his research that focuses on infectious diseases problems that affect reproductive health.

What are some of the most urgent questions you are addressing with your research?

I do a couple of types of research that all stem from interest in primarily bacterial infections that affect pregnancy. These infections can cause a range of conditions, from stillbirth to neonatal sepsis, to premature delivery, to severe infections in the mother. We use group B Streptococcus in the models. My laboratory focuses more on the hosts immune side. We ask questions about how the normal immune system defends itself against potential invading bacteria and how bacteria evade those systems.

About 10 years ago we worked on rare life-threatening Clostridial infections in post-partem or post-abortion women. This work led to focus on difficile. Even though Clostridium difficile is more commonly a gastrointestinal problem affecting older people who had been given antibiotics, this research actually grew out of his original reproductive work. Every human being has to experience birth, and infections are one of the reasons that pregnancy doesn’t always turn out well.

Group B Streptococcus has been a bacterium that has fascinated me in part because it can affect either the child or the mother, by causing an infection in the mom that can cause premature delivery, or the fetus can be born with Streptococcus sepsis. So, it was very attractive that I may be able to work on something that improves the lives of two people, both the mother and the child. We don’t fully understand how the bacteria get in there. There is a lot of need to reduce the burden of infections that prevent pregnancy and to better understand why some women get these infections and some don’t.

I also direct a program on maternal-child health and wellness. There are about 40 to 50 faculty working on subjects ranging from basic science bench-work, to diagnostics, all the way out to simply trying to engage women in low-income environments in care. This group is part of the Pre3 Initiative, which is a space publically supported by Vanderbilt and created to engage learners and students in reproductive health.

Can you discuss your study on the effects of NSAID on microbiome changes?

One study found associated changes in microbiota as a result of nonsteroidal anti-inflammatory drug (NSAID) usage in older adults. We had performed 16s ribosomal DNA analysis from community stool and vaginal samples and clumped medicines into various classes. Since prostaglandins are key to inducing labor and premature birth is one of the most important goals in gynecological medicine, we also examined how the prostaglandin-modifying NSAIDS may impact the microbiome. However, no significant changes in the vaginal microbiome were observed. The finding that stood out the most was that people who had exposure to NSAIDs had distinctive characteristics changes in the microbiome. The microbial changes were consistent among classes of drugs.

Other independent studies have observed this as well. This is particularly interesting since NSAIDs are the most commonly used drug of all. In patients with inflammatory bowel disease who have ulcerative colitis, NSAIDs can set off really bad flares, and we don’t know why that is. Perhaps it has something to do with these changes in the microbiome.

W. Todd Penberthy, PhD is a medical writer with over 4 years of experience based in Orlando, Florida. Prior to that Todd was a professor directing biomedical research using zebrafish models of human disease with expertise in orthomolecular niacin-related science for 10 years. He can be reached at WTPENBER@MAC.COM.