{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:03:07Z","timestamp":1794016987768,"version":"4.8.0"},"reference-count":54,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d","award":["159\/31.01.2022"],"award-info":[{"award-number":["159\/31.01.2022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Cervical cancer is a significant health concern, with the main cause being persistent infection with high-risk Human Papillomavirus (hrHPV). There is still no evidence for why viral persistence occurs in some women, but recent studies have revealed the interplay between cervical microbiota and hrHPV. This research aimed to characterize the cervicovaginal microbiota in cervical lesion progression and HPV infection status. (2) Methods: This study included 85 cervical specimens from women from the north-eastern region of Romania. DNA was isolated from cervical secretion for HPV genotyping and 16S ribosomal RNA gene NGS sequencing. (3) Results: Our study revealed a distinct pattern within the studied group when considering Lactobacillus species, which differs from findings reported in other populations. Specifically, the presence of Lactobacillus iners coupled with the absence of Lactobacillus crispatus alongside Atopobium spp., Prevotella spp., and Gardnerella spp. could serve as defining factors for severe cervical lesions. The results also showed a significant association between microbiota diversity, HPV infection, and cervical lesion progression. (4) Conclusions: As the microbiota profile seems to vary among different populations and individuals, a deeper comprehension of its composition has the potential to develop personalized detection and treatment approaches for cervical dysplasia and cancer.<\/jats:p>","DOI":"10.3390\/jcm12154979","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T02:13:32Z","timestamp":1690769612000},"page":"4979","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Exploring Microbiota Diversity in Cervical Lesion Progression and HPV Infection through 16S rRNA Gene Metagenomic Sequencing"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7788-8189","authenticated-orcid":false,"given":"Irina Livia","family":"Stoian","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Botezatu","sequence":"additional","affiliation":[{"name":"Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Fudulu","sequence":"additional","affiliation":[{"name":"Stefan S. Nicolau Institute of Virology, Romanian Academy, 030304 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian Gavrila","family":"Ilea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-0200","authenticated-orcid":false,"given":"Demetra Gabriela","family":"Socolov","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Grigore T. Popa\u2019 University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"International Agency for Research on Cancer (2022, July 18). Globocan 2020: Romania. Available online: https:\/\/gco.iarc.fr\/today\/data\/factsheets\/populations\/642-romania-fact-sheets.pdf."},{"key":"ref_3","unstructured":"(2021, January 20). Cervical Cancer Death Rate by Country. Available online: https:\/\/www.worldlifeexpectancy.com\/cause-of-death\/cervicalcancer\/by-country\/female."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/S1470-2045(10)70230-8","article-title":"Human papillomavirus genotype attribution in invasive cervical cancer: A retrospective cross-sectional worldwide study","volume":"11","author":"Quint","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Audirac-Chalifour, A., Torres-Poveda, K., Bahena-Rom\u00e1n, M., T\u00e9llez-Sosa, J., Mart\u00ednez-Barnetche, J., Cortina-Ceballos, B., L\u00f3pez-Estrada, G., Delgado-Romero, K., Burguete-Garc\u00eda, A.I., and Cant\u00fa, D. (2016). Cervical Microbiome and Cytokine Profile at Various Stages of Cervical Cancer: A Pilot Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153274"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Curty, G., de Carvalho, P.S., and Soares, M.A. (2019). The Role of the Cervicovaginal Microbiome on the Genesis and as a Biomarker of Premalignant Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21010222"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1073\/pnas.1002611107","article-title":"Vaginal microbiome of reproductive-age women","volume":"108","author":"Ravel","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e3366","DOI":"10.7717\/peerj.3366","article-title":"Quantifying the human vaginal community state types (CSTs) with the species specificity index","volume":"5","author":"Ma","year":"2017","journal-title":"PeerJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3389\/fcimb.2020.00286","article-title":"The Alterations of Vaginal Microbiome in HPV16 Infection as Identified by Shotgun Metagenomic Sequencing","volume":"10","author":"Yang","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tamrakar, R., Yamada, T., Furuta, I., Cho, K., Morikawa, M., Yamada, H., Sakuragi, N., and Minakami, H. (2007). Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women. BMC Infect Dis., 7.","DOI":"10.1186\/1471-2334-7-128"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"181253","DOI":"10.1155\/2008\/181253","article-title":"Temporal Shifts in Microbial Communities in Nonpregnant African-American Women with and without Bacterial Vaginosis","volume":"2008","author":"Wertz","year":"2008","journal-title":"Interdiscip. Perspect. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1128\/JCM.02085-06","article-title":"Cultivation-independent analysis of changes in bacterial vaginosis flora following metronidazole treatment","volume":"45","author":"Ferris","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Gardella, B., Pasquali, M.F., La Verde, M., Cianci, S., Torella, M., and Dominoni, M. (2002). The Complex Interplay between Vaginal Microbiota, HPV Infection, and Immunological Microenvironment in Cervical Intraepithelial Neoplasia: A Literature Review. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23137174"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"16865","DOI":"10.1038\/srep16865","article-title":"Cervical intraepithelial neoplasia disease progression is associated with increased vaginal microbiome diversity","volume":"5","author":"Mitra","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1258\/ijsa.2012.011342","article-title":"Bacterial vaginosis is conducive to the persistence of HPV infection","volume":"23","author":"Guo","year":"2012","journal-title":"Int. J. STD AIDS"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.immuni.2015.04.019","article-title":"Cervicovaginal bacteria are a major modulator of host inflammatory responses in the female genital tract","volume":"42","author":"Anahtar","year":"2015","journal-title":"Immunity"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s40168-016-0203-0","article-title":"The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: What do we know and where are we going next?","volume":"4","author":"Mitra","year":"2016","journal-title":"Microbiome"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lee, J.E., Lee, S., Lee, H., Song, Y.M., Lee, K., Han, M.J., Sung, J., and Ko, G. (2013). Association of the vaginal microbiota with human papillomavirus infection in a Korean twin cohort. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063514"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1093\/infdis\/jiu330","article-title":"Interplay between the temporal dynamics of the vaginal microbiota and human papillomavirus detection","volume":"210","author":"Brotman","year":"2014","journal-title":"J. Infect Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bradshaw, C.S., Walker, J., Fairley, C.K., Chen, M.Y., Tabrizi, S.N., Donovan, B., Kaldor, J.M., McNamee, K., Urban, E., and Walker, S. (2013). Prevalent and incident bacterial vaginosis are associated with sexual and contraceptive behaviours in young Australian women. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0057688"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1001\/jama.2012.3428","article-title":"Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: A systematic review","volume":"307","author":"Chico","year":"2012","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/nar\/gks808","article-title":"Evaluation of general 16S ribosomal RNA gene PCR primers for classical and next-generation sequencing-based diversity studies","volume":"41","author":"Klindworth","year":"2013","journal-title":"Nucleic Acids Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"854164","DOI":"10.3389\/fcimb.2022.854164","article-title":"EasyMap\u2014An Interactive Web Tool for Evaluating and Comparing Associations of Clinical Variables and Microbiome Composition","volume":"12","author":"Dahan","year":"2022","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1038\/nmeth.f.303","article-title":"QIIME allows analysis of high-throughput community sequencing data","volume":"7","author":"Caporaso","year":"2010","journal-title":"Nat. Methods"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"R60","DOI":"10.1186\/gb-2011-12-6-r60","article-title":"Metagenomic biomarker discovery and explanation","volume":"12","author":"Segata","year":"2011","journal-title":"Genome Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1038\/nbt.2676","article-title":"Predictive functional profiling of microbial communities using 16S rRNA marker gene sequences","volume":"31","author":"Langille","year":"2013","journal-title":"Nat. Biotechnol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.nbt.2021.03.001","article-title":"EasyMAP: A user-friendly online platform for analyzing 16S ribosomal DNA sequencing data","volume":"63","author":"Hung","year":"2021","journal-title":"New Biotechnol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"W537","DOI":"10.1093\/nar\/gky379","article-title":"The Galaxy platform for accessible, reproducible and collaborative biomedical analyses: 2018 update","volume":"46","author":"Afgan","year":"2018","journal-title":"Nucleic Acids Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1038\/s41418-019-0384-8","article-title":"A functional genetic screen defines the AKT-induced senescence signaling network","volume":"27","author":"Chan","year":"2020","journal-title":"Cell Death Differ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1158\/1940-6207.CAPR-15-0350","article-title":"Cervical Microbiota Associated with Higher Grade Cervical Intraepithelial Neoplasia in Women Infected with High-Risk Human Papillomaviruses","volume":"9","author":"Piyathilake","year":"2016","journal-title":"Cancer Prev. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10200","DOI":"10.1038\/s41598-017-09842-6","article-title":"Characterization of cervico-vaginal microbiota in women developing persistent high-risk Human Papillomavirus infection","volume":"7","author":"Sani","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"674.e1","DOI":"10.1016\/j.cmi.2015.02.026","article-title":"The association of uterine cervical microbiota with an increased risk for cervical intraepithelial neoplasia in Korea","volume":"21","author":"Oh","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Miko, E., and Barakonyi, A. (2023). The Role of Hydrogen-Peroxide (H2O2) Produced by Vaginal Microbiota in Female Reproductive Health. Antioxidants, 12.","DOI":"10.3390\/antiox12051055"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1086\/503780","article-title":"High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence","volume":"193","author":"Bradshaw","year":"2006","journal-title":"J. Infect Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1038\/ismej.2014.26","article-title":"Lactobacillus-dominated cervicovaginal microbiota associated with reduced HIV\/STI prevalence and genital HIV viral load in African women","volume":"8","author":"Borgdorff","year":"2014","journal-title":"ISME J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.resmic.2017.04.001","article-title":"The role of lactic acid production by probiotic Lactobacillus species in vaginal health","volume":"168","author":"Tachedjian","year":"2017","journal-title":"Res. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/LGT.0000000000000645","article-title":"The Vaginal Microbiome: III. The Vaginal Microbiome in Various Urogenital Disorders","volume":"26","author":"Campisciano","year":"2022","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e14293","DOI":"10.1016\/j.heliyon.2023.e14293","article-title":"Association of Prevotella intermedia with oropharyngeal cancer: A patient-control study","volume":"9","author":"Bustillo","year":"2023","journal-title":"Heliyon"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Teka, B., Yoshida-Court, K., Firdawoke, E., Chanyalew, Z., Gizaw, M., Addissie, A., Mihret, A., Colbert, L.E., Napravnik, T.C., and El Alam, M.B. (2023). Cervicovaginal Microbiota Profiles in Precancerous Lesions and Cervical Cancer among Ethiopian Women. Microorganisms, 11.","DOI":"10.3390\/microorganisms11040833"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5519","DOI":"10.1002\/jmv.28001","article-title":"Prevotella as the hub of the cervicovaginal microbiota affects the occurrence of persistent human papillomavirus infection and cervical lesions in women of childbearing age via host NF-\u03baB\/C-myc","volume":"94","author":"Dong","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"642074","DOI":"10.3389\/fcimb.2022.642074","article-title":"The diversity of vaginal microbiome in women infected with single HPV and multiple genotype HPV infections in China","volume":"12","author":"Liu","year":"2022","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Karpi\u0144ski, T.M. (2019). Role of Oral Microbiota in Cancer Development. Microorganisms, 7.","DOI":"10.3390\/microorganisms7010020"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1600-0463.2010.02641.x","article-title":"Type-specific human papillomavirus detection in cervical smears in Romania","volume":"119","author":"Anton","year":"2011","journal-title":"APMIS"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"7593","DOI":"10.1038\/s41598-018-25879-7","article-title":"Linking cervicovaginal immune signatures, HPV and microbiota composition in cervical carcinogenesis in non-Hispanic and Hispanic women","volume":"8","author":"Barnes","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.21037\/atm-20-5832","article-title":"Association of high-risk human papillomavirus infection duration and cervical lesions with vaginal microbiota composition","volume":"8","author":"Liu","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/aji.12264","article-title":"Bacterial vaginosis and the cervicovaginal immune response","volume":"71","author":"Mitchell","year":"2014","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/B978-0-12-407863-5.00019-8","article-title":"Advancing our understanding of the human microbiome using QIIME","volume":"531","author":"McMurdie","year":"2013","journal-title":"Methods Enzymol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5579608","DOI":"10.1155\/2021\/5579608","article-title":"Correlation Analysis between Gut Microbiota and Metabolites in Children with Systemic Lupus Erythematosus","volume":"2021","author":"Wen","year":"2021","journal-title":"J. Immunol. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e00262-18","DOI":"10.1128\/mSphereDirect.00262-18","article-title":"Metatranscriptome Analysis of the Vaginal Microbiota Reveals Potential Mechanisms for Protection against Metronidazole in Bacterial Vaginosis","volume":"3","author":"Deng","year":"2018","journal-title":"mSphere"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"9720","DOI":"10.1038\/s41598-020-66607-4","article-title":"Taxonomic and Functional Differences in Cervical Microbiome Associated with Cervical Cancer Development","volume":"10","author":"Tango","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.eururo.2018.06.033","article-title":"Metabolic Biosynthesis Pathways Identified from Fecal Microbiome Associated with Prostate Cancer","volume":"74","author":"Liss","year":"2018","journal-title":"Eur. Urol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11306-019-1555-9","article-title":"Recognition of early and late stages of bladder cancer using metabolites and machine learning","volume":"15","author":"Kouznetsova","year":"2019","journal-title":"Metabolomics"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Onywera, H., Anejo-Okopi, J., Mwapagha, L.M., Okendo, J., and Williamson, A.L. (2021). Predictive functional analysis reveals inferred features unique to cervicovaginal microbiota of African women with bacterial vaginosis and high-risk human papillomavirus infection. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0253218"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.cmet.2016.08.009","article-title":"One-carbon metabolism in health and disease","volume":"25","author":"Ducker","year":"2017","journal-title":"Cell Metab."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/15\/4979\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:21:45Z","timestamp":1760127705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/15\/4979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,28]]},"references-count":54,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcm12154979"],"URL":"https:\/\/doi.org\/10.3390\/jcm12154979","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,28]]}}}