Enteral Nutrition in Pediatric Patients Undergoing Hematopoietic SCT Promotes the Recovery of Gut Microbiome Homeostasis

Abstract

Hematopoietic stem cell transplantation (HSCT) is the first-line immunotherapy to treat several hematologic disorders, although it can be associated with many complications reducing the survival rate, such as acute graft-versus-host disease (aGvHD) and infections. Given the fundamental role of the gut microbiome (GM) for host health, it is not surprising that a suboptimal path of GM recovery following HSCT may compromise immune homeostasis and/or increase the risk of opportunistic infections, with an ultimate impact in terms of aGvHD onset. Traditionally, the first nutritional approach in post-HSCT patients is parenteral nutrition (PN), which is associated with several clinical adverse effects, supporting enteral nutrition (EN) as a preferential alternative. The aim of the study was to evaluate the impact of EN vs. PN on the trajectory of compositional and functional GM recovery in pediatric patients undergoing HSCT. The GM structure and short-chain fatty acid (SCFA) production profiles were analyzed longitudinally in twenty pediatric patients receiving HSCT—of which, ten were fed post-transplant with EN and ten with total PN. According to our findings, we observed the prompt recovery of a structural and functional eubiotic GM layout post-HSCT only in EN subjects, thus possibly reducing the risk of systemic infections and GvHD onset.

Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections

“…D'Amico et al analysed longitudinally the trajectory of the compositional and functional recovery of gut microbiota in twenty paediatric patients undergoing HSCT from the same cohort in this study, of which ten were fed post-transplant with EN and ten with total PN. They observed the prompt recovery of a structural and functional eubiotic gut microbiota and short chain fatty acid layout after the disruption induced by the allo-HSCT procedure only in EN patients [45]. These results seemed to support the hypothesis that the reduced incidence of BSI observed in this study may also be explained by the eubiotic effect that EN has on the gut microbiome, promoting homeostasis of the intestinal ecosystem.…”

The gut microbiome in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

“…Moreover, some genera restored in the enteral nutrition group during the post-HSCT recovery were identified, namely Faecalibacterium, Dorea, Blautia, Bacteroides, Parabacteroides, and Oscillospira, which are all well-known health-associated GM components capable of producing SCFA. 64 These findings are in line with the clinical benefit observed with enteral nutrition regarding aGvHD and BSI. 65,66 The role of specific nutritional supplements aimed at promoting a GM mutualistic layout, for example, discrete fiber structures to boost directed SCFA production, 67 has not been explored yet in children undergoing HSCT, but has shown promising preliminary results in adults.…”

The microbiome in pediatric oncology

“…For example, patients who have undergone HCT and have minimal oral intake have lower microbial diversity and differently abundant microbial taxa compared with patients with greater oral intake.15 However, studies of the impact of enteral nutrition on the restoration of a healthy microbiome are less clear. 15,32 Maintaining a healthy microbiome, outside of chemotherapy and antibiotics, by intervening in the nutritional composition of the patient environment is an area in need of further research. Clostridium difficile represents a classic infection occurring within the setting of a perturbed microbiome.…”