Immunoglobulin A response against Gardnerella vaginalis hemolysin and sialidase activity in bacterial vaginosis☆,☆☆,★,★★

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Abstract

Objective: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with bacterial vaginosis. Study Design: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with bacterial vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with bacterial vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial vaginosis was diagnosed by clinical criteria and Gram stain. Results: Sialidase activity was present in 75% (54/72) of patients with bacterial vaginosis. Women having bacterial vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with bacterial vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). Conclusions: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with bacterial vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis. (Am J Obstet Gynecol 1998;178:511-5.)

Section snippets

Subjects and vaginal washings

Participants were recruited among women seeking care at the gynecologic care unit of Azienda per i Servizi Sanitari Medio Friuli, Udine, Italy. All patients were interviewed and examined by one clinician. On entry to the study oral informed consent was sought from all women, who were then interviewed for medical, obstetric, sexual, and contraceptive historic data. Women were excluded from the study for the use of oral or vaginal antibiotics in the past 2 weeks, pregnancy, menstruation or

Results

A total of 222 women were screened for evaluation of sialidase activity. Thirty-two were patients with bacterial vaginosis showing an IgA-specific response to G. vaginalis hemolysin (anti–G. vaginalis toxin IgA-positive subgroup), whereas 40 patients with bacterial vaginosis had anti–G. vaginalis toxin IgA below the cutoff value of 380 mOD (specific IgA-negative subgroup). Two control groups were used: one of 19 patients with candidiasis without bacterial vaginosis and one of 131 healthy

Comment

Our previous detection of a specific IgA response to the G. vaginalis hemolysin in only 55% of women with positive cultures for G. vaginalis14 raised the question of the mechanisms underlying the mucosal immune response in patients with bacterial vaginosis. We have looked for a virulence factor that differs from the G. vaginalis cytolysin to substantiate the existence of differences among patients with bacterial vaginosis. This study demonstrates that a high level of sialidase activity is

Acknowledgements

We are grateful to Ms. Nunziata Verdolina, Azienda per i Servizi Sanitari Medio Friuli n. 4, Udine, for nursing, and to Dr. Maria Pia Francescato, Department of Biomedical Sciences and Technologies, University of Udine, for biostatistical support. We acknowledge students Anna Knezevich and Giusi Zaina for their kind and invaluable assistance during the course of this project.

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    ☆

    From the Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine,a Azienda per i Servizi Sanitari Medio Friuli n. 4,b and the Microbiology Unit, Ospedale S. Maria della Misericordia.c

    ☆☆

    Supported by grants from the University of Udine, Poly-Tech, Trieste, and Italian Consiglio Nazionale delle Ricerche.

    ★

    Received for publication June 23, 1997; revised September 2, 1997; accepted October 9, 1997. Reprint requests: Sabina Cauci, PhD, Department of Biomedical Sciences and Techologies, Via Gervasutta 48, 33100 Udine, Italy.

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