Vaginal epithelial dysfunction is mediated by the microbiome, metabolome, and mTOR signaling.

While mTOR signaling did not reach statistical significance (p = 0.276), Integrin and ILK are shown to activate mTOR, 62 AMPK negatively regulates mTOR, 63 and leukocyte extravasation occurs through mTOR activation. 64 Using GSEA on these samples, transforming growth factor-β and apical junction pathways are highlighted as positively associated (p < 0.05) with ImPA treatment, and others including mTOR signaling trending.

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