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4.1 Influence of vaginal microbiota on biochemical markers The stabilisation of the vaginal microbiota is largely dependent on the presence of Lactobacillus , with strains such as Lactobacillus crispatus and Lactobacillus gasseri playing a particularly significant role.The lactic acid produced by these bacteria maintains the acidic environment of the vagina, which inhibits the multiplication of pathogenic bacteria.In the event of a dysbiotic vaginal microbiota, as observed in cases of bacterial vaginosis or anaerobic bacteria, a localised pro-inflammatory response is initiated, accompanied by a notable elevation in the levels of inflammatory biochemical markers, including IL-1, IL-6 and TNF-

10.1046/j.1523-1755.2001.0590031052.x 63 FyhrquistF.TiituA.SaijonmaaO.ForsblomC.GroopP

Future validation in larger multicenter cohorts is needed, with full multivariable adjustment and inclusion of short-chain acyl-carnitines (C4C6) to assess their added predictive value

This superoxide is rapidly converted into hydrogen peroxide (HO), which, in the presence of Fe 2+ , generates highly reactive hydroxyl radicals (OH) through the Fenton reaction