Arch Gynecol Obstet (2004) 270: 133–146
DOI 10.1007/s00404-004-0623-0
REVIEW
Kaushik Deb
.
Madan Mohan Chaturvedi
.
Yogesh Kumar Jaiswal
Comprehending the role of LPS in Gram-negative bacterial
vaginosis: ogling into the causes of unfulfilled child-wish
Received: 18 October 2003 / Accepted: 1 April 2004 / Published online: 18 June 2004
# Springer-Verlag 2004
Abstract Introduction: Intrauterine infection is fre-
quently associated with pregnancy loss in pregnant
women. Discussion: This article reviews the role of
Gram-negative bacterial infection in various complications
related to early pregnancy and subsequent pregnancy loss.
Here we discus the pathways of ascending intrauterine
infection, microbiology and the pathophysiology of such
infections. The clinical impact, therapy, consequences,
prevention and implications of Gram-negative bacterial
infections in women during their reproductive life span is
also discussed. This article also makes an attempt to
discuss our studies and findings, related to the effect of the
LPS component of the Gram-negative bacterial endotoxin
on preimplantation stage embryonic development and
implantation. This early phase of pregnancy remains
mostly unnoticed by the mother as well as the health care
provider, and therefore holds more threat to the life of the
fetus and the mother. The molecular mechanisms of LPS-
induced pregnancy losses through abnormal embryonic
development, implantation failure, and preterm labor and
birth with specific references to the role of proinflamma-
tory cytokines like IL-1 and TNF are discussed.
Conclusion: Once these inflammatory mediators have
increased in the feto-maternal tissues, it may be too late or
harmful to try and prevent the adverse outcomes of
pregnancy.
Keywords Vaginosis
.
Lipopolysaccharide
.
Endotoxins
.
Implantation
.
Embryo
.
Abortion
.
Pregnancy
.
Cytokines
.
Growth factors
Introduction
Child wish or desire for a child is a result of individual
development, which does not exist from birth and usually
increases with increase with time. In the past 20 years
intrauterine infections have emerged as frequently asso-
ciated with infertility and unfulfilled child wish [37]. It has
been estimated that at least 40% of all preterm births occur
to mothers with intrauterine infection, which is subclinical
in nature. The molecular pathophysiology of this patho-
logic process has been established in the recent years [38].
This knowledge on the molecular mechanisms of preg-
nancy loss induced by pathogenic infections is considered
important, since, by the time a woman is admitted in
spontaneous preterm labour or birth, there may be
irreversible changes in the uterine cervix, which renders
futile the attempts to abrogate the process. It was found
that the earlier in gestation at which pathogenic genital
tract colonization is detected, the greater is the risk of an
adverse outcome. Bacterial vaginosis is a polymicrobial
condition associated with a number of adverse sequelae in
both obstetrics and gynecology [52]. The presence of
enteropharyngeal organisms, such as Esterichia coli or
Enterococus faecalis are some times considered to be a
part of the normal vaginal flora, but are sometimes
considered pathological. However, bacterial vaginosis-
related organisms such as anaerobes Gardnerella vagi-
nallis or Mycoplasma hominis may be considered
indicative of abnormal genital tract flora. Most of these
microbes associated with bacterial vaginosis are Gram-
negative organisms.
Beside genital tract infections systemic maternal infec-
tions of Gram-negative bacteria such as typhoid fever etc.,
has been associated with preterm labour and delivery. All
Gram-negative bacteria possess endotoxins in the cell
walls, which are a group of heat stable lipopolysaccharide
K. Deb (*)
.
Y. K. Jaiswal
Molecular Biology and Reproductive Immunology Laboratory,
School of Studies in Biochemistry, Jiwaji University,
474 011 (MP) Gwalior, India
e-mail: kaushik.deb@vanderbilt.edu
Tel.: +1-615-2603661
M. M. Chaturvedi
Department of Zoology, Delhi University,
110007 Delhi, India
Present address:
K. Deb
Division of Reproductive and Developmental Biology,
Department of Pediatrics, D4100, Medical Center North,
Vanderbilt University Medical School,
Nashville, TN, 37212, USA