Intestinal Blautia Is Associated with Reduced Death from Graft-versus-Host Disease

Abstract

The relationship between intestinal microbiota composition and acute graft-versus-host disease (GVHD) after allogeneic blood/marrow transplantation (allo BMT) is not well understood. Intestinal bacteria have long been thought to contribute to GVHD pathophysiology, but recent animal studies in non-transplant settings have found that anti-inflammatory effects are mediated by certain subpopulations of intestinal commensals. Hypothesizing that a more nuanced relationship may exist between the intestinal bacteria and GVHD, we evaluated the fecal bacterial composition of 64 patients 12 days after BMT. We found that increased bacterial diversity was associated with reduced GVHD-related mortality. Furthermore, harboring increased amounts of bacteria belonging to the genus Blautia was associated with reduced GVHD lethality in this cohort and was confirmed in another independent cohort of 51 patients from the same institution. Blautia abundance was also associated with improved overall survival. We evaluated the abundance of Blautia with respect to clinical factors and found that loss of Blautia was associated with: 1) treatment with antibiotics that inhibit anaerobic bacteria and 2) receiving total parenteral nutrition (TPN) for longer durations. We conclude that increased abundance of commensal bacteria belonging to the Blautia genus is associated with reduced lethal GVHD and improved overall survival.

Heart failure is associated with depletion of core intestinal microbiota

“…Therefore, we conclude that the depletion of Collinsella may be highly specific to HF. Moreover, recent research demonstrated that Blautia might be associated with anti‐inflammatory mechanisms, as its intestinal abundance is associated with reduced death and improved overall survival in Graft‐versus‐Host‐Disease 36. Furthermore, a reduction in the butyrate‐producing genus Faecalibacterium is observed in HF patients.…”

How’s your microbiota? Let’s check your urine.

“…[2][3][4][5] More recently, studies have found that microbiota injury frequently precedes severe GVHD, raising the possibility that loss of protective commensal bacteria during the course of the transplant may contribute to the development of GVHD pathophysiology. [5][6][7] Clinical strategies to intervene when microbiota injury occurs are being developed. To identify high-risk patients who could benefit most, a quick method for determining the "health" of an individual's microbiota would be an invaluable tool.…”

The influence of gut-decontamination prophylactic antibiotics on acute graft-versus-host disease and survival following allogeneic hematopoietic stem cell transplantation

“…15 Subsequently, the same group demonstrated the impact of recipient intestinal flora with high diversity and the abundance of the genus of Blautia as two independent protecting factors for aGVHD. 16 More recently, Soho et al reported in a single-center retrospective study, an increased GVHD related mortality associated to broad spectrum ATB used following aHSCT in adults. Feces composition of patients treated post-aHSCT with piperacillintazobactam was associated with a greater loss of diversity and most notably loss of Bacteroidetes and Lactobacillus.…”

“…This increased mortality appeared to be related to an increased risk of infections and of more severe aGVHD. 15,16 Furthermore, in aHSCT, delayed lymphopenia is considered to be one of the key factors which predict the incidence of aGVHD. 17,18 However, it remains unknown if lymphocyte recovery is influenced by the changes in the composition of the microbiota that are caused by prophylactic ATB treatment.…”