From support to therapy: rethinking the role of nutrition in acute graft-versus-host disease

Abstract

Allogeneic Hematopoietic stem cell transplantation (HSCT) offers a potential cure for patients with hematologic malignancies. Unfortunately, graft-versus-host disease (GVHD) remains a major obstacle to the greater success of this treatment. Despite intensive research efforts over the past several decades, GVHD is still a major cause of morbidity and mortality in patients receiving allogeneic HSCT. The genetic disparity between donor and recipient is the primary factor that dictates the extent of alloimmune response and the severity of acute GVHD (aGVHD). However, some nongenetic factors are also actively involved in GVHD pathogenesis. Thus, identifying host factors that can be readily modified to reduce GVHD risk is of important clinical significance. We are particularly interested in the potential role of nutrition, as a nongenetic factor, in the etiology and management of aGVHD. In this article, we summarize recent findings regarding how different routes of nutritional support and various dietary factors affect aGVHD. Since diet is one of the most important factors that shape gut microbiota, we also provide evidence for a potential link between certain nutrients and gut microbiota in recipients of allogeneic HSCT. We propose a shifting role of nutrition from support to therapy in GVHD by targeting gut microbiota.

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation

“…Examples of such compounds are α-linolenic acid, 18:3 (ω-3), arachidonic acid, 20:4 (ω-6), docosahexaenoic acid, 22:6 (ω-3) (DHA), and eicosapentaenoic acid 20:5 (ω-3) (EPA) [ 84 , 85 , 86 , 87 ]. The omega-6 PUFAs exhibit pro-inflammatory effects by stimulating the production of specific cytokines, while the omega-3 PUFAs are widely regarded as those showing anti-inflammatory and immunomodulatory properties [ 21 ]. The latter belong to a group of macromolecules with well-established evidence of positive impact when used in patients with haematological proliferative diseases, including in patients post-HSCT [ 84 , 85 , 86 , 87 ].…”

“…Nutritional support and a holistic approach are required throughout the journey of post-transplant patients [ 17 , 19 , 20 , 21 ]. Adequate assessment, type of nutrition, and application of novel therapies may prevent malnutrition, further complications, poorer treatment outcomes, and even early death but also improved patients’ quality of life and sense of well-being.…”

Endoscopic manifestation of intestinal transplant-associated microangiopathy after stem cell transplantation

“…Timely diagnosis and intervention are crucial for optimizing the outcomes of patients with iTAM. Meanwhile, in the context of hematopoietic stem cell transplantation, the occurrence of intestinal complications after the procedure encompasses GVHD and cytomegalovirus enteritis as notable examples [ 6 – 8 ]. It is crucial to acknowledge that the treatment approaches for iTAM, GVHD, and cytomegalovirus enteritis differ substantially, underscoring the importance of precise differential diagnoses and expeditious therapeutic interventions to effectively manage these conditions.…”