Category: Bioinformatics

Today, I will be giving a talk at the EDAR8 conference in Brisbane, which will partially cover something that I has been cooking in the research group for some time. It started off with a recurring need to see if a particular antibiotic resistance gene (ARG) was truly new or if it had been detected in previous studies. And after having done the same procedures in several studies, we started to think that maybe it would make sense to build a resource that could be used to keep track of both established and latent ARGs (1) and that could be easily updated over time. And the result is CLEVER – a scheme for Classification of Latent and Established Variants of Extant Antibiotic Resistance Genes.

CLEVER is two things. First, it is a set of definitions for ARGs, making it easier to assign them to categories, for example for risk assessment. Second, it is a database based on these criteria, and to the best of our knowledge the first resource to organize both established and latent ARGs into the same coherent database structure, while still keeping them categorized. To achieve this, CLEVER integrates data from ResFinder (2), CARD (3), ResFinderFG (4), as well as ARGs predicted by the fARGene (5) and MUSTARD (6) tools, gathered from published literature (6-13),

Very briefly, CLEVER is built on the following definitions:

• Established ARG (E): An ARG that is experimentally verified to confer antibiotic resistance and is present in human pathogens.
• Latent ARG (L): An ARG that confers a resistance function (or is predicted to do so), but does not exist in pathogens
• Mobile ARG (M): An ARG which is present on a mobile genetic element, which could be plasmids, integrons, transposons or integrative conjugative elements.
• Chromosomal ARG (C): Any ARG that does not meet the criteria for a mobile ARG above.
• Validated ARG (V): An ARG for which the resistance function has been verified in laboratory experiments, by showing that the presence of the gene increases the MIC of the host compared to an otherwise isogenic strain that does not carry the gene, or alternatively that over-expression of the gene induces a higher MIC compared to an isogenic reference strain.
• Predicted ARG (P): An ARG for which its function has not been verified experimentally (see above), but has been predicted to be an ARG by fARGene
• Structure-predicted ARG (S): An ARG for which its function has not been verified experimentally (see above), but has been predicted to be an ARG based on 3D-structure similarity by MUSTARD

Importantly, what CLEVER also does is to give names (CLEVER IDs) to latent ARGs that currently does not have any consistent way to refer to them. This makes it possible to unambiguously reference a particular ARG family across studies, which is crucial for risk assessment and understanding the spread of AMR.

Finally, by classifying ARGs as established or latent, mobile or chromosomal and verified or predicted makes it possible to identity particular latent ARGs that until now has gone under the radar. Particularly, latent ARGs that already appear on mobile genetic elements and have several mobile variants, are likely to be imminent AMR threats to human health, making them “most-wanted” ARGs that should be targeted for phenotypic evaluation and potential inclusion into AMR surveillance efforts.

By specifically looking into potential ARGs against the last-resort antibiotics carbapenems, colistin, tigecycline and plazomicin, and pulling out latent ARGs that belong to classes potentially conferring resistance to these antibiotics that are already present on plasmids, we can already present a list of five ARGs of imminent concern, which we label the first CLEVER list of most-wanted ARGs: ~blaA-145, ~blaD2-129, ~aac6p-147, ~aph2b-14, and ~aph6-89.

Naturally, there is still a lot work to be done on CLEVER, but I am very proud of what we have already, and I think that the current version (2.0) already has potential to be very useful for AMR studies. We have already started using this internally in the lab and within SEARCHER quite extensively in the last few months, so I am happy to see the use of this resource in the larger AMR community!

References:

1. Inda-Díaz JS, Lund D, Parras-Moltó M, Johnning A, Bengtsson-Palme J, Kristiansson E. Latent antibiotic resistance genes are abundant, diverse, and mobile in human, animal, and environmental microbiomes. Microbiome 2023;11:44. https://doi.org/10.1186/s40168-023-01479-0.
2. Bortolaia V, Kaas RS, Ruppe E, Roberts MC, Schwarz S, Cattoir V, et al. ResFinder 4.0 for predictions of phenotypes from genotypes. Journal of Antimicrobial Chemotherapy 2020;75:3491–500. https://doi.org/10.1093/jac/dkaa345.
3. Jia B, Raphenya AR, Alcock B, Waglechner N, Guo P, Tsang KK, et al. CARD 2017: expansion and model-centric curation of the comprehensive antibiotic resistance database. Nucleic Acids Research 2016:gkw1004. https://doi.org/10.1093/nar/gkw1004.
4. Gschwind R, Ugarcina Perovic S, Weiss M, Petitjean M, Lao J, Coelho LP, et al. ResFinderFG v2.0: a database of antibiotic resistance genes obtained by functional metagenomics. Nucleic Acids Research 2023:gkad384. https://doi.org/10.1093/nar/gkad384.
5. Berglund F, Österlund T, Boulund F, Marathe NP, Larsson DGJ, Kristiansson E. Identification and reconstruction of novel antibiotic resistance genes from metagenomes. Microbiome 2019;7, 52. https://doi.org/10.1186/s40168-019-0670-1
6. Ruppé E, Ghozlane A, Tap J, Pons N, Alvarez A-S, Maziers N, et al. Prediction of the intestinal resistome by a three-dimensional structure-based method. Nature Microbiology 2019;4:112–23. https://doi.org/10.1038/s41564-018-0292-6.
7. Inda-Díaz JS, Lund D, Parras-Moltó M, Johnning A, Bengtsson-Palme J, Kristiansson E. Latent antibiotic resistance genes are abundant, diverse, and mobile in human, animal, and environmental microbiomes. Microbiome 2023;11:44. https://doi.org/10.1186/s40168-023-01479-0.
8. Victor MP, Radisic V, Grevskott DH, Marathe NP. Hospital effluent in a low-resistance setting is responsible for dissemination of novel antibiotic resistance genes into the marine environment. Ecotoxicology and Environmental Safety 2025;301:118390. https://doi.org/10.1016/j.ecoenv.2025.118390.
9. Victor MP, Øvreås L, Marathe NP. Characterization of known and novel clinically important antibiotic resistance genes and novel microbes from wastewater-impacted high Arctic fjord sediments. Science of The Total Environment 2025;985:179699. https://doi.org/10.1016/j.scitotenv.2025.179699.
10. Li B, Jiang L, Johnson T, Wang G, Sun W, Wei G, et al. Global health risks lurking in livestock resistome. Sci Adv 2025;11:eadt8073. https://doi.org/10.1126/sciadv.adt8073.
11. Somerville V, Meola M, Nunes-Richards A, Bengtsson-Palme J, Neukamm J, Majander K, et al. Microbial community dynamics in a traditional Swiss mountain cheese over 142 years of cheesemaking 2026. https://doi.org/10.64898/2026.02.26.708305.
12. Coche‐Miranda J, Arros P, Canales N, Berríos‐Pastén C, Azziz G, Lagos R, et al. Antarctic soil microbiomes encode structurally conserved and phylogenetically diverse beta‐lactamases. iMetaOmics 2026;e70118. https://doi.org/10.1002/imo2.70118.
13. Wang K, Xu J, Li X, Zhu P, Suo R, Lu X, et al. Evolutionary selection of trimethoprim-resistant dfrA genes in lytic phages affects phage and host fitness during infection. Sci Adv 2025;11:eadt4817. https://doi.org/10.1126/sciadv.adt4817.

First of all, I just want to do a last reminder of PhD student position in bioinformatics and artificial intelligence applied to antibiotic resistance with Erik Kristiansson as main supervisor that closes tomorrow. More info here!

Second, two of my best and dearest colleagues at University of Gothenburg – Kaisa Thorell and Åsa Sjöling – have open postdoc positions in molecular microbiology (with Åsa) and bacterial proteomics (with Kaisa). Both of these are great opportunities to work with fantastic people on exciting subjects, so you should check these out if you are looking for postdoc positions in microbiology, molecular biology or bioinformatics! There are only a few days left to apply for these positions, so go ahead and do it now!

Finally, I am again tooting our own horn with the postdoc in innovative approaches to antibiotic resistance monitoring (within the SEARCHER program) in my own group. More info here, deadline is on July 31 with interviews to take place in August.

Erik Kristiansson, who was co-supervisor for my PhD thesis, has an opening for a PhD student funded by the DDLS program. The project is combining bioinformatics and artificial intelligence with a focus on large-scale data analysis to better understand antibiotic resistance and the emergence of novel resistance genes. The research will be centered on DNA sequence analysis, inference in biological networks, and modelling of evolution. The primary applications will be related to antibiotic resistance and bacterial genomics.

I am particularly excited about this position because I will have the benefit of co-supervising the student. The student will also be part of the DDLS research school which is now being launched, which is also super-exciting for Swedish data driven life science.

The candidate is expected to have a degree in bioinformatics, mathematical statistics, mathematics, computer science, physics, molecular biology, or any equivalent topic. Previous experience in analysis of large-scale biological data is desirable. It is important to have good computing and programming skills (e.g. in Python and R), experience with the Linux/UNIX computer environment, and, to the extent possible, previous experience in working with machine learning and/or artificial intelligence.

I had such a good time with Erik as my co-supervisor, and he has put together a truly amazing supervision team with Joakim Larsson, Anna Johnning and myself. I could not imagine a better place to apply bioinformatics and ML/AI on antibiotic resistance! Deadline is June 7! Application link here: https://www.chalmers.se/om-chalmers/arbeta-hos-oss/lediga-tjanster/?rmpage=job&rmjob=12840&rmlang=SE

I have had the fortune to be involved in a study on the quality of reference material for mosquito barcoding for biodiversity studies. The study, which was led by Maurício Moraes Zenker at the Universidade Federal de São Carlos in Brazil, looked at the availability of public data for mosquitoes in online databases for two widely used DNA barcoding markers in Culicidae: the COI and ITS2 regions (1). Last week, this study was published in Scientific Reports.

The paper shows that around 30% of known species were covered for the COI gene in BOLD  and  GenBank, and 12% of species for ITS2 in GenBank. The Afrotropical, Australian and Oriental biogeographic regions had the lowest coverages, while the Nearctic, Palearctic and Oceanian regions had the highest. Countries with a higher diversity of mosquitoes tended to have lower coverage, which was surprisingly also the case for countries with higher numbers of medically important species. At the same time, countries with a higher number of endemic species tended to have a higher species coverage in the databases.

With this study, we would like to advocate for better curatorship of voucher specimens representing sequences in the databases. Also, an integrative taxonomic approach that combines various genetic markers with morphological analyses is important to allow a better use of DNA barcoding and metabarcoding in a diverse array of applications, including vector species detection and biodiversity monitoring.

Importantly, this work underscores how reliant DNA barcoding is on proper taxonomic foundations, including morphological characterisations. Molecular identification of species cannot happen in a vacuum! I would like to extend a big thanks for Maurício who invited me to take part in this study and who have done an excellent job putting it all together!

Reference

• Moraes Zenker M, Pineda Portella T, Costa Pessoa FA, Bengtsson-Palme J, Galetti PM: Low coverage of species constrains the use of DNA barcoding to assess mosquito biodiversity. Scientific Reports, 14, 7432 (2024). doi: 10.1038/s41598-024-58071-1 [Paper link]

My PhD supervisor Joakim Larsson has an opening for a PhD student at University of Gothenburg. The project is on the role of different wastewaters in the evolution of antibiotic resistance, and will be centered on bioinformatic analyses of large-scale data. The project will encompass analysis of bacterial growth curve data through machine learning to antibiotics with selective effects in different wastewaters. Comparative genomics and different AI-based approaches will be applied to large-scale public genome and metagenome data to better understand how resistance genes are mobilized and transferred to pathogens.

Joakim is a great scientist with a vibrant group, so if your interests is in line with the position, I strongly suggest you take a look at it! Deadline is October 30! Application link here: https://web103.reachmee.com/ext/I005/1035/job?site=7&lang=UK&validator=9b89bead79bb7258ad55c8d75228e5b7&job_id=30401

My colleague and friend Clemens Wittenbecher has an open doctoral student position at Chalmers in Data-Driven Precision Health Research. Clemens works with developing novel biomarker panels to quantify individual disease risk. The project itself will focus on innovative machine learning and artificial intelligence approaches to integrate multi-layer -omics data with bioimages of cardiovascular and metabolic tissues (computer tomography, ultrasound and magnetic resonance imaging).

Clemens is a fantastic person and a great supervisor so if your interests is in line with the position, I strongly suggest you take a look at it! Application link here:

https://www.chalmers.se/en/about-chalmers/work-with-us/vacancies/?rmpage=job&rmjob=11810&rmlang=UK

I just want to point potential doctoral students’ attention to this fantastic opportunity to work with my EMBARK colleague Luis Pedro Coelho as he sets up his new lab in Brisbane in Australia at the relatively new Centre for Microbiome Research. Luis is looking for two PhD students, one who will focus on identifying and characterising the small proteins of the global microbiome and one more related to developing novel bioinformatic methods for studying microbial communities.

I can highly recommend this opportunity given that you are willing to move to Australia, as Luis is one of the most brilliant scientists I have worked with, is incredibly easy-going and fosters a lab culture I strong support. More information and application here.

I am happy to share with you that since a couple of months back there is an up-to-date version of ITSx available through Galaxy! The tool can be found here: https://usegalaxy.eu/root?tool_id=itsx

The person behind this is really Björn Grüning at the University of Freiburg. I am immensely thankful for the work he has put into this. Our intention to make sure that both the Galaxy version and the bioconda version are maintained in parallel to the one on this website, and continuously up to date!

Happy barcoding!

In just a few days, Environment International has published two papers coming out from the EMBARK consortium which are somewhat connected to each other.

The first (or technically the second, but the other order makes more sense when explaining this…) is the first paper involving most of the people who have been working in the EMBARK consortium for an extended period of time. It’s an overview paper titled “Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement Itit, and what are the data needs?” (1) and I think the title describes the topic pretty well. Basically, we go through why it would be interesting to monitor for antibiotic resistance in the environments, how that could be implemented and what we would need to know to get there.

The very condensed story is that if one is considering implementing monitoring for environmental resistance, these are a few things that should be considered:

• The purpose of monitoring: What is the motivation? What should be achieved? What type of risk should be assessed? What type of action would monitoring enable?
• Choice of methods: Which methods are economically feasible? Which methods would deliver results within a useful timeframe for taking appropriate actions?
• Targeted environments: In what type of environment would monitoring for a given purpose be worthwhile?
• Intended users: Who would be able to use, implement and act upon this strategy?
• Integration potential: How does this monitoring integrate with other monitoring efforts? How can the resulting data be communicated?

We then dive into the knowledge gaps we are currently facing, and particularly highlight the following areas:

• Establish how different existing methods for monitoring resistance compare to each other
• Extend pathogen-centric databases for resistance genes with latent resistance genes (2)
• Determine the locations and type of environments relevant for resistance monitoring
  To reduce costs, utilizing already existing environmental monitoring should be prioritized, as should locations integrated into operating or planned surveillance programs. More efforts should also be made to identify additional pathways for resistance transmission through the environment.
• Study the environment as a source and transmission route for antibiotic resistance
  Stratify risks associated with resistance genes found in the environment. Define typical levels of antibiotic resistance in different environments (3), and define how these levels change over time.
• Identify settings where the relationship between fecal bacteria and antibiotic resistance is absent
  Usually, these levels follow each other, but the environments where they don’t are important as they deviate from the expected baseline of resistance. This knowledge can aid in identifying situations in which it would be helpful to investigate a microbial community for resistance to specific antibiotics.
• Identify the origins for more antibiotic resistance genes (4)
  This knowledge will be instrumental in preventing the emergence of new forms of resistance in pathogens in the future.

An important outcome of this paper is that we realise that we are still not at a level of understanding where routine monitoring for resistance in the environment can be easily justified or implemented. Still, there is a need for monitoring data in natural environments to even get started, and therefore we support the implementation of national, regional and global of initiatives without having all the scientific answers. The lack of comprehensive understanding should not be an obstacle to starting environmental monitoring for AMR, nor for action against environmental development and spread of AMR.

The second paper is very much related to the first, in that it actually tries to address one of these knowledge gaps: the need for normal background levels of antibiotic resistance in different environments. In this paper, Anna Abramova did an herculean effort collecting (we hope) all qPCR data on antibiotic resistance gene abundances in the environment for the past two decades. All in all, she collected data for more than 1500 samples across 150 studies and integrated these into an analys of what we could consider normal levels of resistance in different environments.

For an ‘average’ resistance gene, we found that the normal relative abundance range was form 10^-5 to 10^-3 copies per bacterial 16S rRNA, or that around one in 1,000 bacteria would carry a given resistance gene. This level varied quite a bit between different resistance genes, however, but not so much between environmental types (except for in human and animal feces, where some resistance genes were clearly more abundant, most prominently tetracycline resistance genes). What was more striking was that there was a clear difference between environments impacted or likely impacted by human activities, as opposed to more pristine environments with little to none human impact. Some resistance genes, such as tetA, tetG, blaTEM and blaCTX-M, showed very marked differences between these impacted and non-impacted environments, making them great markers of human-activity-associated resistance.

Our final recommendations with regards to monitoring include:

• Include the intI1, sul1, blaTEM, blaCTX-M and qnrS genes in environmental monitoring, along with a selection of tetracycline resistance genes, including either tetA or tetG.
• Other potential target genes could be sul3, vanA, tetH, aadA2, floR, ereA and mexF, which are abundant in some environments, but are not often included in qPCR studies of environmental AMR
• If a gene deviates from the expected 10^-5 to 10^-3 interval, this warrants further investigation of the causes.
• Maximum acceptable levels need to be determined not only taking relative abundances of genes into account, but also risks to human health as well as the numbers of bacteria in a given volume of sample into account (5,6) and transmission routes to humans (7)
• The different standards of reporting DNA abundances constituted a complicating factor for this study. Both abundances of resistance genes relative to the 16S rRNA gene and to the sample volume or weight should be reported.
• The absence of clear trends of increases or decreases in resistance gene abundances over time indicates a need for more systematic time series data in a variety of environments.

Our results also highlighted the scarcity of resistance gene data from parts of the world, particularly from Africa and South America, and underscores the need for a concerted effort to quantify typical background levels of resistance in the environment more broadly to enable efficient environmental surveillance schemes akin to those that exist in clinical and veterinary settings.

I encourage anyone with an interesting these topics to at least skim the full papers [Monitoring overview paper here, Normal qPCR resistance abundances here]. These will be great resources and I am very proud of them both. I would really like to thank the entire EMBARK team and our collaborators in CORNELIA, WastPAN and in other organisations. I would also like to thank Anna for her hard work on collecting and analysing the qPCR data for around two years. It has been a long ride, and I think we are both happy, proud and a bit relieved to finally see this paper published!

References

1. Bengtsson-Palme J, Abramova A, Berendonk TU, Coelho LP, Forslund SK, Gschwind R, Heikinheimo A, Jarquin-Diaz VH, Khan AA, Klümper U, Löber U, Nekoro M, Osińska AD, Ugarcina Perovic S, Pitkänen T, Rødland EK, Ruppé E, Wasteson Y, Wester AL, Zahra R: Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs? Environment International, 108089 (2023). doi: 10.1016/j.envint.2023.108089
2. Inda-Díaz JS, Lund D, Parras-Moltó M, Johnning A, Bengtsson-Palme J, Kristiansson E: Latent antibiotic resistance genes are abundant, diverse, and mobile in human, animal, and environmental microbiomes. Microbiome, 11, 44 (2023). doi: 10.1186/s40168-023-01479-0
3. Abramova A, Berendonk TU, Bengtsson-Palme J: A global baseline for qPCR-determined antimicrobial resistance gene prevalence across environments. Environment International, 178, 108084 (2023). doi: 10.1016/j.envint.2023.108084
4. Ebmeyer S, Kristiansson E, Larsson DGJ: A framework for identifying the recent origins of mobile antibiotic resistance genes. Communications Biology, 4 (2021). doi:10.1038/s42003-020-01545-5
5. Larsson DGJ, Andremont A, Bengtsson-Palme J, Brandt KK, de Roda Husman AM, Fagerstedt P, Fick J, Flach C-F, Gaze WH, Kuroda M, Kvint K, Laxminarayan R, Manaia CM, Nielsen KM, Ploy M-C, Segovia C, Simonet P, Smalla K, Snape J, Topp E, van Hengel A, Verner-Jeffreys DW, Virta MPJ, Wellington EM, Wernersson A-S: Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. Environment International, 117, 132–138 (2018). doi: 10.1016/j.envint.2018.04.041
6. Pruden A, Larsson DGJ, Amézquita A, Collignon P, Brandt KK, Graham DW, et al. Management options for reducing the release of antibiotics and antibiotic resistance genes to the environment. Environmental Health Perspectives, 121, 878–885 (2013). doi:10.1289/ehp.1206446
7. Bengtsson-Palme J, Kristiansson E, Larsson DGJ: Environmental factors influencing the development and spread of antibiotic resistance. FEMS Microbiology Reviews, 42, 1, 68–80 (2018). doi: 10.1093/femsre/fux053

Together with our collaborators in Tromsø in Norway, we published a paper over the weekend in eBioMedicine describing the early colonization patterns of preterm infants, both in terms of the microbes that arrive early to the infants, but also in terms of the antibiotic resistance genes they carry.

In the paper (1), which is a continuation of an earlier study by part of the team (2), we analysed metagenomic data from six Norwegian neonatal intensive care units to better understand the bacterial microbiota of infants born preterm or on term and receiving different treatments. These groups included probiotic-supplemented and antibiotic-exposed extremely preterm infants (n = 29), antibiotic-exposed very preterm infants (n = 25), antibiotic-unexposed very preterm infants (n = 8), and antibiotic-unexposed full-term infants (n = 10). Stool samples were collected from the infants after 7, 28, 120, and 365 days of life and were analysed using shotgun metagenomics. We were particularly interested in the maturation of the preterm infant microbiome into a ‘normal’ healthy gut microbiome, and the colonization with bacteria carrying antibiotic resistance genes.

We found that microbiota maturation was largely determined by the length of hospitalisation for the infants and how much preterm they were. The use of probiotics rendered the gut microbiota and resistome of extremely preterm infants more alike to term infants on day 7 and partially restored the loss of species interconnectivity and stability associated with preterm delivery. Finally, colonisation with Escherichia coli was associated with the highest number of antibiotic-resistance genes in the infant microbiomes, followed by Klebsiella pneumoniae and Klebsiella aerogenes.

Being born very preterm, along with prolonged hospitalisation and frequent antibiotic use alters early life resistome and mobilome, leading to an increased gut carriage of antibiotic resistance genes and mobile genetic elements. On the other hand, the effect of probiotics was not unidirectional. Probiotics decreased resistome burden, but at the same time the bacterial strains in the probiotics appear to promote the activity of mobile genetic elements. Here, further study of the gut microbiota is necessary to be able to design strategies aiming to lower disease risk in vulnerable preterm infants.

As mentioned, this study was a collaboration with Veronika Pettersen‘s group in Tromsø, particularly Ahmed Bargheet, who have done a fabulous job on the bioinformatics and analysis of this study. I hope that we will continue this collaboration in the future (first step will be me visting Tromsø again in June!) This also continues a nice little “sidetrack” of the group’s research into the early life microbiome – previously represented by the work of Katariina Pärnänen (3) and Tove Wikström‘s vaginal microbiome study (4), which is a very interesting and relevant subject in terms of both medicine and microbial ecology. We are also setting up new collaborations in this area, so I hope that more will come out of this track in the next couple of years.

Finally, thank you Veronika for inviting me to participate in this great project!

References

1. Bargheet A, Klingenberg C, Esaiassen E, Hjerde E, Cavanagh JP, Bengtsson-Palme J, Pettersen VK: Development of early life gut resistome and mobilome across gestational ages and microbiota-modifying treatments. eBio Medicine, 92, 104613 (2023). doi: 10.1016/j.ebiom.2023.104613
2. Esaiassen E, Hjerde E, Cavanagh JP, Pedersen T, Andresen JH, Rettedal SI, Støen R, Nakstad B, Willassen NP, Klingenberg C: Effects of Probiotic Supplementation on the Gut Microbiota and Antibiotic Resistome Development in Preterm Infants. Frontiers in Pediatrics, 16, 6, 347 (2018). doi: 10.3389/fped.2018.00347
3. Pärnänen K, Karkman A, Hultman J, Lyra C, Bengtsson-Palme J, Larsson DGJ, Rautava S, Isolauri E, Salminen S, Kumar H, Satokari R, Virta M: Maternal gut and breast milk microbiota affect infant gut antibiotic resistome and mobile genetic elements. Nature Communications, 9, 3891 (2018). doi: 10.1038/s41467-018-06393-w
4. Wikström T, Abrahamsson S, Bengtsson-Palme J, Ek CJ, Kuusela P, Rekabdar E, Lindgren P, Wennerholm UB, Jacobsson B, Valentin L, Hagberg H: Microbial and human transcriptome in vaginal fluid at midgestation: association with spontaneous preterm delivery. Clinical and Translational Medicine, 12, 9, e1023 (2022). doi: 10.1002/ctm2.1023