Rupert Kaul, PhD, MD, FRCPC

Clinician Scientist, Toronto General Hospital Research Institute (TGHRI)
https://orcid.org/0000-0002-1586-4093
Keywords: sexually transmitted infections, female sex workers, T cell responses, mucosal immunology, HIV resistance, Africa, HIV/AIDS
Dr Kaul's research interests focus on: (1) the genital immune correlates of HIV transmission and susceptibility in the male and female genital tract; (2) the role of the gut mucosa in HIV pathogenesis and disease; and (3) the epidemiology of HIV and coinfections in HIV-affected Toronto communities. This research is based in clinical cohorts from Canada, Kenya and Uganda. His work is supported by a Memorandum of Understanding with the University of Nairobi, and by research funding from the OHTN, CIHR, NIH and Gates Foundation.

Sustained impact of LACTIN-V (Lactobacillus crispatus CTV-05) on genital immunology following standard bacterial vaginosis treatment: results from a randomized placebo-controlled trial

Study Status: Completed
Study Purpose: This study aimed to see if using a pill containing LACTIN-V bacteria (Lactobacillus crispatus CTV-05) after using a standard treatment for bacterial vaginosis had a long-term effect on the vagina.
Background: The bacteria in the vagina of all women is known as the vaginal microbiome. Good vaginal health is associated with good levels of the bacterial species, Lactobacillus crispatus. Bacterial vaginosis occurs when the amount of good and bad bacteria in the vagina becomes unbalanced. This causes increased inflammation, increased the risk of HIV, sexually transmitted infections, premature birth, and poor reproductive health. We previously showed that vaginal inflammation was dramatically reduced with treatment. Unfortunately, bacterial vaginosis usually returns after treatment. We are now examining whether a pill containing the bacteria Lactobacillus crispatus has a longer effect on vaginal inflammation. Lactobacillus crispatus bacteria is known to help prevent bacterial vaginosis from returning.
Study Methods: This study was a randomized clinical trial to understand the pill’s effectiveness and safety. The trial involved women aged 18 to 45 years with bacterial vaginosis. 3 months of the new pill’s treatment was shown to reduce the return of bacterial vaginosis from 45% to 30%. A follow up study then looked at whether there were more long-term effects on the vagina after stopping the new pill.
Key Findings: We found that use of the new pill after standard treatment led to reduced levels of vaginal inflammation that were still present 3 months later. There was also evidence of less tissue damage in the vagina. These effects would be expected to reduce HIV risk and improve other aspects of womens’ reproductive health.
Health Conditions: Women’s Health (Gynecology)

 

Defining the determinants of penile microbiome transmission and stability: implications for HIV risk

Study Status: Active
Study Purpose: This study seeks to understand what makes up the penile microbiome. The study also aims to test treatments that can optimize the penile microbiome and reduce HIV risk. Penile microbiome components are transmitted during condomless penile-vaginal sex. They have an important impact on HIV risk and can be modified by antibiotic treatments.
Background: Most sexual exposures to HIV do not result in virus transmission. Immune factors in the lining (mucosa) of the genital tract are important to how susceptible a person is to HIV. A more activated immune environment increases HIV risk, while a less-active immune environment is protective. Our recent work found that penile bacteria (microbiome) affects  HIV risk for men. There is evidence that bacteria from the penile microbiome can be transmitted during sex. However, the degree to which bacteria transmission happens during sex is not well studied in men. Some bacteria increase inflammation and HIV risk, while others may be protective. Exciting initial work from our team shows that penile-vaginal sex has dramatic effects on penile immunology, and also that certain antibiotics can alter the penile microbiome and reduce HIV susceptibility.
Study Methods: Three separate projects are being performed. The first will study the sexual transmission and stability of key bacterial components, using samples collected before and after penile-vaginal sex. Participants are part of the Toronto SEx and Couples Study (SECS). We will then study how key genital bacteria affect penile immunology. Finally, we will study how these same immune and bacterial factors affect antibiotic  treatments.
Health Conditions: Infectious Diseases (HIV/AIDS, TB, etc.)

 

Clinician Scientist, Toronto General Hospital Research Institute (TGHRI)

Professor, Departments of Medicine and Immunology, University of Toronto
Director, Division of Infectious Diseases, UHN and University of Toronto