Associations between acute gastrointestinal GvHD and the baseline gut microbiota of allogeneic hematopoietic stem cell transplant recipients and donors

摘要

Growing evidence suggests that host-microbiota interactions influence GvHD risk following allogeneic hematopoietic stem cell transplant. However, little is known about the influence of the transplant recipient's pre-conditioning microbiota nor the influence of the transplant donor's microbiota. Our study examines associations between acute gastrointestinal GvHD (agGvHD) and 16S rRNA fecal bacterial profiles in a prospective cohort of A/=57 recipients before preparative conditioning, as well as N = 22 of their paired HLA-matched sibling donors. On average, recipients had lower fecal bacterial diversity (P=0.0002) and different phylogenetic membership (UniFrac P=0.001) than the healthy transplant donors. Recipients with lower phylogenetic diversity had higher overall mortality rates (hazard ratio = 0.37, P = 0.008), but no statistically significant difference in agGvHD risk. In contrast, high bacterial donor diversity was associated with decreased agGvHD risk (odds ratio = 0.12, P = 0.038). Further investigation is warranted as to whether selection of hematopoietic stem cell transplant donors with high gut microbiota diversity and/or other specific compositional attributes may reduce agGvHD incidence, and by what mechanisms. The success of allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains limited by GvHD. Even among transplants sourced from 'gold standard' donors (HLA-matched siblings), acute GvHD occurs in 35-45% of recipients,1'2 highlighting the need to continue investigating GvHD etiology and new strategies for prophylaxis. The 16S rRNA sequencing has enabled a dramatic re-evaluation of the relationships between GvHD and the intestinal bacteria.3"5 The pre-transplant microbiota of recipients has been reported to approximate the diverse microbiota compositions of healthy adults before transplant, but becomes dramatically altered following transplant procedures.