Anti-Inflammatory Effect of Surfactant Lipid in the Vaginal Mucosa: A Pilot Study

Objective The aim of the study was to test the hypothesis that vaginal administration of surfactant lipids, which may counter-balance the proinflammatory effects of vaginal surfactant protein A, will decrease proinflammatory cytokines and increase anti-inflammatory cytokines in vaginal mucosal fluid in healthy women. Materials and Methods Three groups of healthy cycling women were randomized to receive vaginally a single dose of the following: (1) low-dose calfactant, a type of surfactant lipids, 0.8 mg/ml; (2) high-dose calfactant 8.0 mg/ml; or (3) placebo, at the time of resolution of menses. Vaginal mucosal fluid was collected before administration and also 1 and 8 days after administration of each treatment. After 1 mo, each group was randomized to each alternative treatment; thus, for a 3-month treatment period, each group received each of the 3 treatments. Vaginal fluid was tested using a Multiplex Immunoassay System. Cytokine concentrations on day 1 and day 8 were compared with day zero and tested for significance with the Student's t test. Results Six healthy subjects completed each treatment. Subjects given high-dose calfactant had, by day 8, a significant reduction in macrophage chemotactic protein-1 and interleukin 15 (IL-15) compared with low-dose calfactant or placebo. High-dose calfactant resulted in an increase in anti-inflammatory cytokines that trended toward significance on day 1 (IL-1RA) or day 8 (IL-10). Conclusions This pilot study in healthy women demonstrates that calfactant reduces proinflammatory cytokines and increases anti-inflammatory cytokines in the vagina. We propose that calfactant may be an effective vaginal anti-inflammatory therapy for inflammatory vaginitis and similar disorders for which current therapy is ineffective.