Saccharomyces cerevisiae als levend biotherapeuticum tegen vulvovaginale candidiasis

Vulvovaginal candidiasis (VVC) is a widespread fungal infection of the vaginal mucosa caused by Candida species, most notably C. albicans. Despite its high global prevalence and considerable impact on women's health and well-being, VVC remains under-recognized and often sidelined due to the stigma surrounding intimate health and persistent gender disparities in medical research and care. Epidemiological data estimate that up to 75% of women will experience at least one episode of VVC during their lifetime, with 7-9% suffering from recurrent VVC (RVVC), defined as three or more episodes annually. This equates to an estimated 138 million cases per year worldwide. Clinically, VVC presents with distressing symptoms and signs including clumpy white discharge, burning, pruritus, erythema, and dyspareunia, which significantly impair both physical comfort and psychological well-being. Alarmingly, around 20% of affected women report inadequate relief with currently available antifungal therapies, underscoring a critical gap in treatment efficacy. Traditionally, VVC has long been treated with a singular focus on eradicating fungal load. However, growing consensus now recognizes VVC as a classic example of mucosal immunopathology. In C. albicans-driven VVC, disease pathology is not solely attributable to fungal proliferation but arises from a dysfunctional host immune response. Neutrophils, key players in antifungal immunity, are abundantly recruited to the site of infection but fail to resolve the fungal burden. Instead, they contribute to epithelial damage and perpetuate inflammatory signaling, establishing a cycle of tissue destruction and symptom persistence. This dissertation investigates Saccharomyces cerevisiae as a novel, host-compatible, live biotherapeutic product (LBP) for the treatment of VVC. S. cerevisiae strain Sc3458 was established as a scientifically validated, microbiome-compatible, and therapeutically versatile live biotherapeutic for the treatment of VVC. By simultaneously attenuating fungal virulence and recalibrating host immune responses, Sc3458 addresses both arms of the disease process. Its compatibility with endogenous lactobacilli and efficacy against multiple Candida species further reinforces its translational value. In an era marked by rising antifungal resistance and persistent gaps in women's health, Sc3458 offers a compelling alternative to conventional therapies, one that is both mechanistically grounded and ecologically compatible.