Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis

Objective The objective of the study was to determine whether vestibular fibroblasts from vulvar vestibulitis (VVS) patients produce higher proinflammatory cytokine levels when provoked with Candida albicans (yeast) and alpha - melanocyte-stimulating hormone (α-MSH) in vitro. Study Design Twenty anatomically defined fibroblast strains from patients and age-matched controls were stimulated with 5 regimens: no stimulus, α-MSH, heat-killed yeast, α-MSH plus yeast, and interleukin (IL)-1β. Supernatant products included the following: granulocyte macrophage colony-stimulating factor, interferon-γ, IL-10, IL-12, IL-1β, IL-2, IL-4, IL-6, IL-8, and tumor necrosis factor-α were assayed. Results Coincubation with α-MSH plus yeast significantly increased IL-6 (3-fold) and IL-8 (greater than 40-fold) production in patients and controls. Vestibular fibroblast exceeded external vulvar fibroblast production of IL-1β, IL-6, and IL-8 following yeast alone and α-MSH plus yeast stimuli in patients and controls. Substratified by anatomic origin, vestibular fibroblasts from VVS patients produced the highest relative levels of IL-1β, IL-6, and IL-8 at baseline and following the yeast-alone regimen. Conclusion Localized pain of VVS may results from regionally elevated cytokines produced by vulvar vestibule–specific fibroblasts.