Changes in intestinal microbiota and their effects on allogeneic stem cell transplantation

Abstract

The human intestinal microbiota is essential for microbial homeostasis, regulation of metabolism, and intestinal immune tolerance. Rapidly evolving understanding of the importance of the microbiota implicates changes in the composition and function of intestinal microbial communities in an assortment of systemic conditions. Complications following allogeneic stem cell transplant now join the ever-expanding list of pathologic states regulated by intestinal microbiota. Dysbiosis, or disruption of the normal ecology of this microbiome, has been directly implicated in the pathogenesis of entities such as Clostridium difficile infections, graft-versus-host disease (GVHD), and most recently disease relapse, all of which are major causes of morbidity and mortality in patients undergoing allogeneic stem cell transplant. In this review, we elucidate the key origins of microbiotic alterations and discuss how dysbiosis influences complications following allogeneic stem cell transplant. Our emerging understanding of the importance of a balanced and diverse intestinal microbiota is prompting investigation into the appropriate treatment of dysbiosis, reliable and early detection of such, and ultimately its prevention in patients to improve the outcome following allogeneic hematopoietic stem cell transplant.

A gut microbiota score predicting acute graft-versus-host disease following myeloablative allogeneic hematopoietic stem cell transplantation

“…The gut microbiota is associated with the development of aGVHD, and loss of microbiota diversity is an independent risk factor for aGVHD . In this study, we demonstrated that the constitution of the microbiota at engraftment following myeloablative allo‐HSCT is associated with aGVHD.…”

“…The gut microbiota is associated with the development of aGVHD, and loss of microbiota diversity is an independent risk factor for aGVHD. 15,[21][22][23] In this study, we demonstrated that the constitution of the microbiota at engraftment following myeloablative allo-HSCT is associated with aGVHD. Furthermore, we used the LASSO algorithm to develop and validate a model in which the GMS could predict the subsequent occurrence and development of aGVHD.…”

“…Increasing numbers of studies have demonstrated that the gut microbiome plays an important role in the development of aGVHD . However, the relevant microbiota found to be related to aGVHD was not consistent among different transplant centers .…”

“…In this and our prior studies, we demonstrated that both the di- Increasing numbers of studies have demonstrated that the gut microbiome plays an important role in the development of aGVHD. 21,23,25,26 However, the relevant microbiota found to be related to aGVHD was not consistent among different transplant centers. 5,15,22,[25][26][27][28] It may be interpreted that gut microbiota are impacted by many factors, such as antibiotics, conditioning, diet, and geographic environment, 11,15,[29][30][31] and our previous studies have demonstrated such phenomena.…”

The Gut Microbiota and Hematopoietic Stem Cell Transplantation: Challenges and Potentials

“…Several studies have demonstrated a protective effect of enteral feeding in GvHD [32]. On the other hand, total parenteral feeding enhances proinflammatory cytokines [33] and most likely aggravates the immune responses in allo-HSCT patients.…”