Investigation and in vivo validation of the anti-Candida activity of probiotic metabolites in the vaginal niche

Silke Baldewijns
Persbericht

Biergist als oplossing voor vaginale schimmelinfecties

Wist u dat dezelfde gist die gebruikt wordt om uw lievelingsbiertje te brouwen ook een positieve impact kan hebben op de gezondheid van vele vrouwen? Uit onderzoek van biologe Silke Baldewijns (KU Leuven) blijkt de behandeling van vaginale schimmelinfecties met biergist veel potentieel te bezitten.

Vrouw met pijn

Wereldwijd ervaren ongeveer 138 miljoen vrouwen vier of meer vaginale schimmelinfecties per jaar en dit cijfer zal tegen 2030 waarschijnlijk nog stijgen tot 158 miljoen. De symptomen van een vaginale schimmelinfectie zijn niet enkel onaangenaam, ze kunnen ook de mentale gezondheid en levenskwaliteit van vrouwen aantasten. Tijdens een zwangerschap kan een vaginale schimmelinfectie zelfs de gezondheid en normale geboorte van een kind in gevaar brengen.

Vulvovaginale candidiasis

Vulvovaginale candidiasis is een vaginale schimmelinfectie die veroorzaakt wordt door Candida. Net als in de darm, leven in de vagina verschillende soorten bacteriën en gisten, waaronder ook Candida. Al deze micro-organismen houden elkaar in evenwicht en maken samen het vaginale microbioom. Wanneer dit evenwicht verstoord geraakt kunnen bepaalde micro-organismen de overhand krijgen en een infectie veroorzaken. Vulvovaginale candidiasis wordt in de meeste gevallen veroorzaakt door Candida albicans en in mindere mate door Candida glabrata.

Wat is er mis met huidige behandelingen?

De huidige behandeling van vulvovaginale candidiasis bestaat uit de toediening van antischimmelmiddelen zoals bijvoorbeeld vaginale zalven op basis van miconazol of orale capsules met fluconazol. Uit recent klinisch onderzoek blijkt echter dat er steeds meer resistente Candida varianten voorkomen in de vagina waartegen antischimmelmiddelen veel minder effectief zijn. Door een regelmatige blootstelling aan antischimmelmiddelen hebben deze varianten manieren gevonden om zichzelf aan te passen en zo de werking van de antischimmelmiddelen te verminderen. Ook is er gebleken dat antischimmelmiddelen het vaginale microbioom nadelig kunnen beïnvloeden. Omwille van al deze redenen is er nood aan effectieve alternatieven voor de behandeling van vulvovaginale candidiasis.

Probiotica als alternatief

Probiotica zijn levende organismen die, indien toegediend in voldoende mate, een gunstig effect kunnen hebben op de gezondheid van de gebruiker. Op dit moment zijn de meest gebruikte micro-organismen als probiotica tegen vaginale schimmelinfecties Lactobacillus bacteriën. Deze bacteriën, gekend voor onder andere de productie van yoghurt, zetten melksuiker om in melkzuur en worden daarom melkzuurbacteriën genoemd. De effectiviteit van zowel melkzuur als melkzuurbacteriën tegen vaginale Candida infecties is echter controversieel. De resultaten van verschillende studies spreken elkaar tegen en men weet voorlopig nog niet zeker hoe dit komt. Nog een belangrijk nadeel van bacterie-gebaseerde probiotica is dat ze niet gecombineerd kunnen worden met antibiotica behandelingen. Dit is zeer spijtig aangezien men schat dat 35% van de vaginale schimmelinfecties veroorzaakt worden door antibiotica. Daarom is de ontwikkeling van probiotica die niet gebaseerd zijn op bacteriën maar op gisten, zoals de biergist Saccharomyces cerevisiae, veelbelovend.

Is biergist dé oplossing?

Een glas bier

Saccharomyces cerevisiae is één van de best bestudeerde en meest gebruikte gisten in probiotica, maar ook voor industriële doeleinden zoals de productie van wijn, bier, wodka, brood, chocolade en bio-ethanol. Saccharomyces cerevisiae als probioticum beperkt zich voorlopig vooral tot aandoeningen van de darm zoals de ziekte van Crohn, prikkelbare-darmsyndroom en antibiotica-geassocieerde diarree. Uit recent onderzoek is echter gebleken dat deze gist ook potentieel heeft tegen vaginale Candida infecties.

Hoe?

Biergist kan de concentraties van bepaalde organische zuren verhogen in de vagina. In het onderzoek van Silke Baldewijns werd het effect van deze zuren op de groei van Candida vergeleken met het effect van melkzuur. De resultaten toonden aan dat melkzuur de groei van Candida stimuleert in plaats van het te belemmeren. Dit suggereert dat probiotica, gebaseerd op melkzuurbacteriën, misschien niet de meest effectieve manier is om vaginale schimmelinfecties te behandelen. In tegenstelling tot melkzuur, konden de biergist-geassocieerde zuren wel de groei van Candida in de vagina remmen.

Biergist kan azijnzuur produceren. In het tweede deel van het onderzoek werd het combinatie-effect van azijnzuur en het antischimmelmiddel fluconazol onderzocht. Waarom is dit interessant? Zoals eerder vermeld, worden er steeds meer Candida varianten in de vagina gevonden die resistent zijn tegen fluconazol en/of andere antischimmelmiddelen. Om deze reden is het zeer relevant om te testen of azijnzuur mogelijks de effectiviteit van bepaalde antischimmelmiddelen zou kunnen verhogen om zo ook resistente Candida varianten te bestrijden. De resultaten voor het combinatie-effect waren niet eenduidig. Eén test gaf aan dat het effect van azijnzuur en fluconazol samen groter is dan de som van elk van beiden apart. Helaas gaf een andere test dit niet aan. De combinatie fluconazol – azijnzuur zal dus nog beter onderzocht moeten worden vooraleer ze in praktijk gebruikt kan worden.

Veelbelovende resultaten

Witte muis

In het laatste deel van het onderzoek werd een probiotische behandeling op basis van biergist getest in een diermodel. Er werd een muizenexperiment gedaan waarin het effect van biergist op een vaginale Candida infectie vergeleken werd met het effect van een antischimmelmiddel. In de eerste dagen na de behandeling had de met biergist behandelde groep minder Candida in de vagina dan de onbehandelde en de met antischimmelmiddel behandelde groep. Hoewel dit zeer veelbelovend was, nam dit effect een ​​paar dagen later af. Er is dus zeker nog optimalisatie nodig.

Samen bewijzen de resultaten van deze studie alvast dat er zeker potentieel zit in de behandeling van vaginale schimmelinfecties met de biergist, Saccharomyces cerevisiae.

Wat brengt de toekomst?

Omdat ze haar masterthesis zo interessant vond en enorm gelooft in het potentieel van het project, heeft Silke Baldewijns ondertussen een doctoraatsaanvraag ingediend. Op deze manier hoopt ze onderzoek te kunnen blijven doen binnen hetzelfde project. “Ik heb helaas zelf al kunnen ondervinden hoe vervelend vaginale schimmelinfecties kunnen zijn. Hierdoor ben ik alleen maar extra gemotiveerd om mijn steentje bij te dragen aan mogelijke oplossingen. Ik hoop dat ik in de toekomst veel vrouwen zal kunnen helpen met de resultaten van dit project.”

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Universiteit of Hogeschool
Master of biology
Publicatiejaar
2021
Promotor(en)
Dr. Liesbeth Demuyser; Prof. Dr. Patrick Van Dijck
Kernwoorden
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