Understanding the Role of Biogenic Amines in Vaginal Dysbiosis & BV

In 2013 we published the first untargeted metabolomic analysis of vaginal samples from women with or without bacterial vaginosis (BV). This paper highlighted the biogenic amines, putrescine and cadaverine as important characteristic compounds of symptomatic BV, being directly associated with the clinical sign malodor. Other studies published before and after this work have supported these findings using various methods and implicated additional biogenic amines (BAs), including trimethylamine and agmatine. We have since shown that many of these compounds increase as women transition from a healthy Lactobacillus spp.-dominant vaginal microbiome to a suboptimal Lactobacillus spp.-depauperate dysbiotic state.

BAs are organic compounds with one or more amine (NH2) group. In addition to agmatine, cadaverine, putrescine, and trimethylamine (described above), other common BAs include tyramine, spermine, and spermidine, which are also part of the vaginal metabolome. Intriguingly, BAs may be important factors that facilitate the transition from healthy Lactobacillus spp.-dominant microbiomes to suboptimal Lactobacillus spp.-depauperate states and BV.

The majority of healthy women (~70 %) have vaginal microbiomes that are dominated by Lactobacillus spp. These lactobacilli ferment vaginal glycogen to produce lactic acid and in doing so create an acidic (pH ~3.5 – 4.5) environment that limits the colonizing potential and outgrowth of other microbes, including potential pathogens. Acidified lactate, along with other antimicrobial activities of the Lactobacillus spp.  (i.e. the production of hydrogen peroxide and bacteriocins) provides one of the most important barriers to uropathogenic invasion.

Many BAs are primarily produced via specific amino acid decarboxylation (AAD) pathways. Because AAD reactions consume protons, the production of BAs may actively reduce pH. Various microbes produce BAs including agmatine, putrescine, and cadaverine  at acidic pH as part of the ornithine-, arginine-, and lysine- dependent acid resistance pathways. The decarboxylation of arginine to produce agmatine, for example, has been seen to protect E. coli strains at pH 2.5, while the other two pathways are more active at pH 4 – 6 (similar to that seen in the vagina).

Using a dual Gas-chromatography (GC)- and High Pressure Liquid Chromatography (HPLC)- Mass Spectrometry (MS) metabolomic approach, we have shown that women with low or no Lactobacillus species in their vaginal microbiota had significantly higher vaginal concentrations of the BAs cadaverine, putrescine, and agmatine than women whose vaginal microbiota were dominated by Lactobacillus crispatus or Lactobacillus iners (These are the two most common Lactobacillus species other common community profiles (dominated by L. jensenii or L. gasseri) were not seen in this study. Additionally, our analyses revealed that the precursor amino acids to each of these BAs (lysine, methionine, ornithine, arginine, and tyrosine) were all significantly lower in women with low or no Lactobacillus species. In contrast spermine and spermidine were higher in these women. This later result is consistent with previous work that demonstrated increases in spermidine and/or spermine within the vaginal fluid of women without BV when compared to women with BV. More recently we used a targeted metabolomic approach to analyzed twelve women who, as part of the Human Microbiome Project, were sampled daily over 10 weeks and seen to transition from a Lactobacillus spp.-dominant microbiome to a low or no Lactobacillus species dysbiotic state. In this longitudinal study we quantitatively assessed all BAs and their precursor amino acids and observed significant increases in the BAs cadaverine, putrescine, and tyramine with simultaneous decreases in the amino acids arginine, lysine, ornithine and tryptophan and the BAs spermine and spermidine immediately prior to the depletion of lactobacilli and outgrowth of other bacteria.

BAs may also increase the rates of sexually transmitted infections (STI) as they have been shown to enhance the virulence of various pathogens, including Neisseria gonorrhoeae (the causative agent of Gonorrhea), which has been shown to have greater resistance to host innate immunological defenses in the presence of BAs and have greater resistance to lactic acid in the presence of either exogenous BAs or their precursor amino acids.

Collectively, these observations show elevated concentrations of select BAs are associated with the reduction in healthy vaginal lactobacilli and transition to a dysbiotic low-Lactobacillus species state. They also point to BAs as potentially underscoring the increased risks of urogenital infection. What drives these increases in BAs remains to be determined. We have shown that only a few common vaginal microbes are capable of producing BAs, and that these same microbes are not only more abundant in low-Lactobacillus species states, but begin to rapidly increase as pH increases. Some BAs, specifically putrescine, spermine, and spermidine may also be produced by the human host where they play roles in immune regulation, lipid metabolism, nucleic acid stabilization, and cell division. It is therefore possible that endogenous metabolism contributes to vaginal BA concentrations.

The outcomes of this study may finally elucidate the enigmatic mechanism underpinning the onset of vaginal dysbiosis and bacterial vaginosis, something that has eluded researchers for more than 100 years. It is hoped that it will also lead to the development of novel therapeutics and a more wholistic approach to women’s health.

This project could not be possible without the support of NIH-NIAID, NIH-NIGMS, MT-INBRE, AI/AN-CTRP and our collaborators, Drs. Jacques Ravel, Rebecca Brotman, and Michelle Shardell at the University Maryland School of Medicine.

This project has supported the the following students and postdoctoral fellows:

Current Lab Members

Joanna-Lynn Borgogna, Ph.D.
Postdoctoral Fellow

Madelaine Brown
PhD candidate

Darien Kadriu
Undergraduate Researcher

Past Lab Members

Tiffany Nelson
Postdoctoral Fellow

Elisa Santori
Undergraduate Researcher

Benjamin Americus
Undergraduate Researcher

Deanna DeSon
Undergraduate Researcher

Related Publications

Overview of the vaginal microbiome

Borgogna JC, Yeoman CJ. 2017. The Application of Molecular Methods to Improving Our Understanding of the Vaginal Microbiomes Role in Health and Disease. In: Methods in Microbiology (book chapter). Ed. Colin Harwood. Elsevier. 44: 37 – 91. DOI: 10.1016/bs.mim.2017.08.003

Biogenic amines are associated with a low-Lactobacillus microbiota and bacterial vaginosis

Nelson TM, Borgogna JL, Brotman RM, Ravel J, Walk ST, Yeoman CJ. 2015. Vaginal biogenic amines: Biomarkers of bacterial vaginosis or precursors to vaginal dysbiosis? Front. Physiol. 6: 253

Borgogna JC, Shardell MD, Grace SGSantori EKAmericus B, Li Z, Ulanov AV, Forney LJ, Nelson T, Brotman RM, Ravel J, Yeoman CJ. 2021. Biogenic amines increase the odds of bacterial vaginosis and affect the growth and lactic acid production by vaginal Lactobacillus sp. Applied and Environmental Microbiology. In press.

Yeoman CJ, Thomas SM, Berg Miller ME, Ulano AV, Torralba M, Lucas S, et al. 2013. A multi-omic systems-based approach reveals metabolic markers of bacterial vaginosis and insight into the disease. PLoS One 8(2): e56111. doi:10.1371/journal.pone.0056111

Biogenic amines are associated with STI

Borgogna JC, Shardell MD, Santori EKNelson TM, Rath JM, Glover ED, Ravel J, Gravitt P, Yeoman CJ, Brotman RM. 2019. The vaginal metabolome and microbiota of cervical HPV-positive and HPV-negative women: a cross-sectional analysis. British Journal of Obstetrics & Gynecology. 2020 Jan;127(2):182-192doi: 10.1111/1471-0528.15981. Epub 2019 Nov 20. PubMed PMID: 31749298; PubMed Central PMCID: PMC6982399.

Borgogna JC, Shardell MD, Brotman RM, Yeoman CJ, Ghanem KG, Kadriu H, Ulanov AV, Gaydos CA, Hardick J, Robinson C, Ravel J, Bavoil PM, Tuddenham S. 2020. Vaginal metabolomics profiles: comparing uninfected, C. trachomatis mono- and C. trachomatis/M. genitalium co-infected women. Scientific Reports. 10: 3420 DOI: 10.1038/s41598-020-60179-z

Biogenic amines are influenced by host behaviors

Nelson TM, Borgogna JC, Michalek, RD, Roberts DW, Rath JM, Glover ED, Ravel J, Shardell MD, Yeoman CJ, Brotman RM. 2018. Cigarette smoking is associated with an altered vaginal tract metabolomic profile. Scientific Reports. 8: 852. PubMed PMID: 29339821; PubMed Central PMCID: PMC5770521; DOI:10.1038/s41598-017-14943-3

Other papers on the vaginal microbiome

Walther-António MR, Jeraldo P, Berg Miller ME, Yeoman CJ, Nelson KE, Wilson BA, White BA, Chia N, Creedon DJ. 2014. Pregnancy’s stronghold on the vaginal microbiome. PLoS One 9: e98514

Yildirim S, Yeoman CJ, Janga SC, Thomas SM, Ho M, Leigh SR, Consortium PM, White BA, Wilson BA, Stumpf RM. 2014. Primate vaginal microbiomes exhibit species specificity without universal Lactobacillus dominance. ISME J. 8: 2431 – 2444.

Swartz JD, Lachman M, Westveer K, O’Neill T, Geary T, Kott RW, Berardinelli JG, Hatfield PG, Thomson JM, Roberts A, Yeoman CJ. 2014. Characterization of the vaginal microbiota of ewes and cows reveals a unique microbiota with low levels of lactobacilli and near-neutral pH. Front. Vet. Sci. 1: 19.

Stumpf RM, Wilson BA, Rivera A, Yildirim S, Yeoman CJ, White BA, Polk JD, Leigh SR. 2013. Primate vaginal microbial ecology: Comparative context and implications for human health and disease. Am. J. Phys. Anthropol. 57: 119 – 134.

Yeoman CJ, Yildirim S, Thomas SM, Durkin AS, Torralba M, Sutton G, et al. 2010. Comparative genomics of Gardnerella vaginalis strains reveals substantial differences in metabolic and virulence potential. PLoS ONE. 5: e12411. doi:10.1371/journal.pone.0012411