4.2 Article

Intestinal Microbiota Can Predict Acute Graft-versus-Host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation

Journal

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 25, Issue 10, Pages 1944-1955

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2019.07.006

Keywords

Intestinal microbiota; Microbiota marker; Microbiota diversity; Acute graft-versus-host disease; Allogeneic hematopoietic stem cell transplantation

Funding

  1. National Natural Science Foundation of China [U1401221, 81770190, 81870144, 81600141, 81700176, 81470349]
  2. National Primary Research Plan [2017YFA105500, 2017YFA105504]
  3. Science and Technology Major Planning Project of Guangdong Province [2014B020226004]
  4. Natural Science Foundation of Guangdong Province [2016A030310390, 2017A030310102]
  5. Guangzhou Science and Technology Plan Project [201906010094]
  6. Medical Science and Technology Planning Project of Henan Province [201403227]

Ask authors/readers for more resources

The intestinal microbiome plays an important role in the development of acute graft-versus-host disease (aGVHD). However, whether intestinal microbiota can predict the development of aGVHD has been reported only rarely. Here we conducted a prospective study of microbiota in 141 patients after allogeneic hematopoietic stem cell transplantation. We found lower microbiota diversity in the aGVHD group compared with the non-aGVHD group at day 0 and day 15 +/- 1 (P = .018 and .009, respectively). Diversity was negatively associated with conditioning intensity (P = .017, day 0; P = .045, day 15) and beta-lactam antibiotic administration (P = .004, day 15). Intensified conditioning and beta-lactam antibiotics were associated with a lower regulatory T (Treg)/T helper 17 (Th17) cell ratio at day 15 (P = .030 and .047, respectively). At day 15, the levels of the inflammatory factors (tumor necrosis factor a, interleukin [IL]-6, IL-17A, IL-1 beta, and lipopolysaccharide) were higher in the intensified conditioning group compared with the standard group (P < .05). The accumulated intestinal microbiota (AIM) score was defined as microbiota diversity and gradient of the 4 bacterials (Lachnospiraceae, Peptostreptococcaceae, Erysipelotrichaceae, and Enterobacteriaceae) at day 15 post-transplantation. The AIM score was positively correlated with aGVHD grade (r = .481, P < .001), and the AIM score could be predictive of the development of aGVHD (grade II-IV aGVHD: area under the curve [AUC], .75, P < .001; grade III-IV aGVHD: AUC, .84, P < .001). These findings suggest that intestinal microbiota and conditioning might induce aGVHD by inflammatory factors and the Treg/Th17 balance. The constitution of the intestinal microbiota at neutrophil engraftment may predict the development of aGVHD. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

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