Effects of Golden Sea Cucumber Extract (Stichopus hermanni) on Hyphae, Neutrophils and TNF-α in BALB/c Mice Inoculated with C. albicans Intravaginally

Introduction: Candidal vaginitis is an inflammatory disease that caused mainly by Candida albicans. Yeast transitions to filamentous hyphae considered the most important virulence factor. Neutrophils are the first line of defense of the immune system, but in patients with Candidal vaginitis the recruitment of neutrophils into the vaginal lumen is positively correlated with symptoms of the disease. This is supported by the release of proinflammatory cytokines such as TNF-α. Standard treatment is considered less effective in relieving symptoms, so other alternative/adjunctive treatments are needed. Golden sea cucumber (Stichopus hermanni) extract has been widely studied, especially for anti-fungal and anti-inflammatory. This study aims to analyze the mechanism of decreasing number of hyphae and neutrophils, and proinflammatory cytokine TNF-α in BALB/c mice inoculated intravaginally with C. albicans after administration of golden sea cucumber extract (S. hermanni). Methods: Experimental research uses a post-test only control group design. The experimental unit consisted of 36 BALB/c mice that were inoculated intravaginally with C. albicans and divided into 4 groups, group that did not receive treatment (K-), group that received standard treatment fluconazole (K+), group that received treatment with golden sea cucumber extract (S. hermanni) (P1) and group that received standard treatment with fluconazole plus extract of golden sea cucumber (S. hermanni) (P2). The hyphae and neutrophils number were seen microscopically on vaginal mucosal tissue. Cytokine levels of TNF-α were seen from the ELISA blood samples. Results: Results showed from the vaginal mucosal tissue of mice, there was significant difference in the number of hyphae (p = 0.001) between groups and no significant difference in the number of neutrophils (p = 0.070) between groups. From the blood serum of mice, there were significant differences in TNF-α levels (p=0.001) between groups. From the path analysis obtained a significant relationship from the number of hyphae to the number of neutrophils (p = 0.034) and the number of neutrophils to TNF-α levels (p = 0.021). The strength of the pathway from number of hyphae to number of neutrophils (β= 0.354) and number of neutrophils to TNF-α levels (β= 0.382) with positive interactions all. Conclusion: In summary, the administration of S. hermanni extract was able to reduce the number of hyphae, neutrophils and TNF-α levels through the hyphae, neutrophil and TNF-α pathway.