Vitamin E deficiency and reduced aromatase level are associated with Gardnerella vaginalis colonization in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a frequent endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and high risk of bacterial vaginosis. The development of hormonal imbalances is connected with the reduced activity of the aromatase enzyme (CYP19A1), oxidative stress and vaginal microbiome disruption. Objective: This paper explores the relationship between vitamin E status, aromatase serum level and vaginal microbiome dysbiosis in PCOS. Methods: The case-control study included 89 PCOS and 30 healthy women. The concentration of total testosterone, estradiol 2, procalcitonin (PCT), luteinizing (LH), follicle-stimulating (FSH) hormones, and IL-6 in serum were measured using electrochemiluminescence immunoassay (ECLIA) technology. The level of vitamin E, aromatase, TNF-α and IL-6 levels were estimated with the appropriate ELISA Kits. Vaginal swabs were used for diagnosing bacterial vaginosis with the Nugent scoring procedure. Vaginal swab smears were inoculated on HBT agar to identify and promote the growth of Gardnerella vaginalis. Results: PCOS patients exhibited elevated LH, testosterone, PCT, TNF-α, IL-6 and higher vaginal pH, with reduced FSH, estradiol 2, vitamin E, and aromatase compared to controls (P < 0.001). Bacterial vaginosis was present in 48.3% of PCOS women, with 100% G. vaginalis positivity and biofilm formation, versus G. vaginalis negativity in controls (P < 0.001). Conclusion: Our findings showed that vitamin E insufficiency and reduced aromatase levels in women with PCOS generate a highly favorable microenvironment for vaginal dysbiosis, resulting in a high frequency of bacterial vaginosis caused mostly by the biofilm-producing Gardnerella vaginalis. Keywords: aromatase, Gardnerella vaginalis, hormonal imbalance, polycystic ovary syndrome, vaginal microbiome, vitamin E