4.2. Clinical implications
The etiopathogenesis of BV is not completely delineated. Nonetheless,
formation of a pathogenic biofilm—principally by Gardnerella
vaginalis —is a prime event in bacterial vaginosis.8,
39 This biofilm has an augmented propensity to attach to vaginal
epithelial cells, consequently mediating the adherence and propagation
of additional bacterial vaginosis-associated anaerobes, for instance,Atopobium vaginae and others. The end result in bacterial
vaginosis is a substitution in vaginal microbiota composition from
normal Gram-positive lactobacilli to pathogenic anaerobic bacteria, most
prominently Gardnerella vaginalis .8, 39 This
biofilm barrier persists after therapy. Additionally, it contributes to
treatment resistance and relapse by reducing the penetration capability
of drugs targeting bacterial vaginosis 8, 40.
Astodrimer gel emerges as a novel therapy for treatment of bacterial
vaginosis. When compared to conventional antibiotics, astodrimer gel
holds several substantial advantages. Most importantly, astodrimer gel
exhibits a unique non-antibiotic based activity against biofilms, in
terms of dismantling and suppressing the formation of biofilms
implicated in the pathogenesis of bacterial vaginosis. This anti-biofilm
activity is principally related to the structural features of
astodrimer. To elaborate, astodrimer is a large-sized molecule with
negative charge, which favorably impedes the capacity of bacteria to
attach to epithelial surfaces, thus eventually inhibiting and disrupting
biofilms. This non-antibiotic mechanism of action is highly beneficial,
particularly for patients who are intolerant of current antibiotic
medications or those who desire a substitute management option. Also,
astodrimer gel may be appealing to patients who fail to respond to
various conventional antibiotics. Eventually, astodrimer gel evades the
hurdle of antibiotic resistance. The satisfactory pharmacokinetic
properties of astodrimer gel—particularly local drug application and
lack of systemic absorption—further encourage its use in patients with
bacterial vaginosis. With regard to safety, astodrimer gel is largely
well endured and the rate of posttreatment candidiasis overgrowth is
marginal. Overall, astodrimer gel carries the prospect to satisfy the
gap of unmet clinical necessity for a more suitable treatment option for
patients with bacterial vaginosis.