Exploring New Treatments for Bacterial Vaginosis: Evaluating the Synergistic Effects of Prebiotics and Lactic Acid on Lactobacillus Crispatus growth

Background: Bacterial vaginosis (BV) is a common vaginal condition caused by an imbalance in the microbiome.Lactobacillus crispatus plays a key role in vaginal health by producing lactic acid, which lowers pH and inhibits growth of bacteria causing BV.Prebiotic and postbiotic compounds such as D-mannose, glycogen, inulin and lactic acid might help restore a healthy vaginal microenvironment by stimulating growth of L. crispatus.Methods: Concentrations of D-mannose, glycogen, inulin, and lactic acid for enhancing L. crispatus were screened.Growth curves of L. crispatus in the presence and absence of these compounds (1-10 mg/ml, LMRS media) were obtained from 16-hour incubations, and biofilm assays were performed on select concentrations.Results: Specific prebiotic and postbiotic enhancers can significantly promote the growth of L. crispatus in liquid media when added in the concentration range of 1-6 mg/ml.Inulin (I) was the most efficient enhancer (31-56% relative enhancement) of the three prebiotics.The combination of D-mannose (M) and glycogen (G) had the strongest relative enhancement (152%).Adding D-lactic acid (DLA) in a triple combination increased growth rates across all combinations, with G+I+DLA mix yielding the highest enhancement (162%).Biofilms data showed dramatic enhancements for the following combinations: 208% for M+G+DLA, 177% for G+I+DLA, and 144% for M+I+DLA. Conclusions:This preliminary study highlights the potential of enhancer supplementation to stimulate regrowth of L. crispatus, which could be the foundation of a viable strategy in the treatment of recurrent BV.