Cervicovaginal microbiota: a promising direction for prevention and treatment in cervical cancer

Abstract

Cervical cancer is a common malignancy in women, with high incidence rate and mortality. Persistent infection of high-risk human papillomavirus (HPV) is the most important risk factor for cervical cancer and precancerous lesions. Cervicovaginal microbiota (CVM) plays an essential role in the defense of HPV infections and prevention of subsequent lesions. Dominance of Lactobacillus is the key of CVM homeostasis, which can be regulated by host, exogenous and endogenous factors. Dysbiosis of CVM, including altered microbial, metabolic, and immune signatures, can contribute to persist HPV infection, leading to cervical cancer. However, there is no evidence of the causality between CVM and cervical cancer, and the underlying mechanism remains unexplored. Considering the close correlation between CVM dysbiosis and persistent HPV infection, this review will overview CVM, its role in cervical cancer development and related mechanisms, and the prospects for therapeutic applications.

Keywords: Cancer treatment; Cervical cancer; Cervicovaginal microbiota; Human papillomavirus.

Fig. 1

The role of cervicovaginal microbiota (CVM) in cervical cancer (CC). The homeostasis of CVM is dominated by Lactobacillus, forming an acidic microenvironment against pathogens invasion, such as HPV infection. Affected by host, exogenous, and endogenous factors, it turns to dysbiosis, a pro-inflammatory microenvironment with anaerobes dominance. Altered microbial, metabolic, and immune signatures lead to persist HPV infection and carcinogenesis. CVM differs in HPV/CIN/CC, so specific microbial species can be used as biomarkers. Modulation of CVM can enhance therapeutic efficacy, reduce adverse reactions and improve life quality. HPV: human papilloma virus. CIN: cervical intraepithelial neoplasia

Fig. 2

Representation of cervicovaginal bacterial community groups. CST: community state type