<b>Introduction and Hypothesis:</b> <p>Pelvic organ prolapse (POP) is a common condition with poorly understood mechanisms. Metabolic endotoxemia and gut microbiome dysbiosis may impair connective tissue integrity, contributing to POP. We hypothesized that women with POP have a distinct gut microbiome and greater systemic inflammation than controls.</p> <b>Methods:</b> <p>This prospective cohort study enrolled patients undergoing hysterectomy for benign indications from February 2023 to February 2024. Stool, blood, and uterosacral ligament (USL) biopsies were collected. Gut microbiome composition, including alpha and beta diversity and differential abundance of bacterial taxa, was assessed. In addition, plasma inflammatory markers and histologic inflammation were also evaluated.</p> <b>Results:</b> <p>Eighty-six patients were analyzed. Alpha diversity was higher in POP patients by observed features (<i>p</i> = 0.048) and increased with prolapse stage, but these associations did not persist after adjusting for age. Beta diversity showed no distinct patterns. Clostridia vadinBB60 group, Eubacteriales, and Rhodospirillales increased with advancing stage, persisting after age adjustment. Plasma lipopolysaccharide-binding protein (LBP) and histologic inflammation were significantly higher in POP patients, while lipopolysaccharide (LPS) and zonulin were comparable.</p> <b>Conclusions:</b> <p>Women with POP exhibited modest gut microbiome differences. Greater microbial richness paralleled prolapse severity but was largely attributable to age. In contrast, stage-associated enrichment of Clostridia vadinBB60 group, Eubacteriales, and Rhodospirillales persisted after age adjustment, suggesting taxonomic shifts specific to prolapse rather than aging alone. Elevated histologic inflammation and plasma LBP suggest a systemic inflammatory response consistent with an inflamm-aging framework. Together, these findings support a possible gut–pelvic floor axis and may provide groundwork for microbiome- and inflammation-targeted therapies.</p>

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Gut microbiome profile and inflammatory response in pelvic organ prolapse: A pilot study

  • Ashley E. Hilton,
  • Dylan M. Asmar,
  • David J. Orlicky,
  • Jaime S. Arruda,
  • Lauren G. Rascoff,
  • Juana A. Hutchinson Colas,
  • Ivana Yang,
  • Marsha K. Guess,
  • Joshua Johnson,
  • Kathleen A. Connell

摘要

Introduction and Hypothesis:

Pelvic organ prolapse (POP) is a common condition with poorly understood mechanisms. Metabolic endotoxemia and gut microbiome dysbiosis may impair connective tissue integrity, contributing to POP. We hypothesized that women with POP have a distinct gut microbiome and greater systemic inflammation than controls.

Methods:

This prospective cohort study enrolled patients undergoing hysterectomy for benign indications from February 2023 to February 2024. Stool, blood, and uterosacral ligament (USL) biopsies were collected. Gut microbiome composition, including alpha and beta diversity and differential abundance of bacterial taxa, was assessed. In addition, plasma inflammatory markers and histologic inflammation were also evaluated.

Results:

Eighty-six patients were analyzed. Alpha diversity was higher in POP patients by observed features (p = 0.048) and increased with prolapse stage, but these associations did not persist after adjusting for age. Beta diversity showed no distinct patterns. Clostridia vadinBB60 group, Eubacteriales, and Rhodospirillales increased with advancing stage, persisting after age adjustment. Plasma lipopolysaccharide-binding protein (LBP) and histologic inflammation were significantly higher in POP patients, while lipopolysaccharide (LPS) and zonulin were comparable.

Conclusions:

Women with POP exhibited modest gut microbiome differences. Greater microbial richness paralleled prolapse severity but was largely attributable to age. In contrast, stage-associated enrichment of Clostridia vadinBB60 group, Eubacteriales, and Rhodospirillales persisted after age adjustment, suggesting taxonomic shifts specific to prolapse rather than aging alone. Elevated histologic inflammation and plasma LBP suggest a systemic inflammatory response consistent with an inflamm-aging framework. Together, these findings support a possible gut–pelvic floor axis and may provide groundwork for microbiome- and inflammation-targeted therapies.