Work

Effect of vaginal microbial infections on the efficacy of 5-aminolevulinic acid-mediated photodynamic therapy for vaginal intraepithelial neoplasia

Year: 2025

Type: article

Abstract: • ALA-PDT is a safe and well-tolerated option in the treatment vaginal intraepithelial neoplasia (VAIN) lesions. • High efficacy could be achieved for ALA-PDT of VAIN accompanied by high-risk HPV infection. • The status of vaginal microbiota has significant impacts on the treatment success of ALA-PDT. • Patients with imbalanced vaginal microbiota and mixed infections show less satisfactory outcomes. Vaginal intraepithelial neoplasia (VAIN) is a precancerous condition with significant potential for malignant transformation. The 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is considered as a novel approach to treat VAIN. Recent studies have shown that an imbalance in the vaginal microbiota can affect the progression of VAIN. Thus, the effect of imbalanced microbiota on the efficacy of ALA-PDT for treating VAIN needs to be determined. Sixty-five female patients diagnosed with VAIN were recruited. 5-aminolevulinic acid was applied topically to the vaginal wall, followed by 635 nm red light at intervals of 7–14 days. Cytological inspections, high risk human papillomavirus (HR-HPV) genotyping, vaginal colposcopy examinations, histopathology and culture and identification of vaginal microflora were performed before and after treatment. Among the 62 patients, the complete remission rate (CRR) of vaginal wall lesions was 85.5%, and the HR-HPV clearance rate was 61.3%. In the balanced vaginal microbiota group, the CRR of vaginal wall lesions reached 97.2%, with an HR-HPV clearance rate of 75.1%. In the imbalanced vaginal microbiota group, the CRR of vaginal wall lesions was only 65.5%, with an HR-HPV clearance rate of 48.3%. There was a trend of improved clearance of lesions and HR-HPV when the vaginal microbiota was balanced ( p = 0.002 and p = 0.038, respectively). During the process of clinical treatment and the 1-year follow-up period, all patients experienced minimal adverse reactions. The findings of this study demonstrate that ALA-PDT is a clinically effective and safe treatment for VAIN, and the vaginal microbiota’s status is a key factor affecting the efficacy of ALA-PDT for VAIN.

Source: Photodiagnosis and Photodynamic Therapy

DOI: 10.1016/j.pdpdt.2025.105289

Authors: Hongxia Yao, Jie Liu, Jingjing Wang, Yu Zhu, Xiaowen Pu

Institutions: Tongji University, Shanghai First Maternity and Infant Hospital

Language: English

Topic: Photodynamic Therapy Research Studies

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,610