Antibiotic-mediated modification of the intestinal microbiome in allogeneic hematopoietic stem cell transplantation

被引:46
作者
Whangbo, J. [1 ,2 ,3 ]
Ritz, J. [1 ,2 ]
Bhatt, A. [4 ,5 ]
机构
[1] Dana Farber Canc Inst, Div Hematol Malignancies, Boston, MA 02115 USA
[2] Harvard Med Sch, Boston, MA USA
[3] Boston Childrens Hosp, Div Hematol Oncol, Boston, MA USA
[4] Stanford Univ, Dept Med, 269 Campus Dr, Stanford, CA 94305 USA
[5] Stanford Univ, Dept Genet, 269 Campus Dr, Stanford, CA 94305 USA
关键词
VERSUS-HOST-DISEASE; REGULATORY T-CELLS; BONE-MARROW-TRANSPLANTATION; MOUSE RADIATION CHIMERAS; GUT MICROBIOTA; PROTECTIVE ENVIRONMENT; INFLAMMATORY DISEASE; SECONDARY DISEASE; BACTERIA; MICE;
D O I
10.1038/bmt.2016.206
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Allogeneic hematopoietic stem cell transplantation (HSCT) is curative for many patients with severe benign and malignant hematologic disorders. The success of allogeneic HSCT is limited by the development of transplant-related complications such as acute graft-versus-host disease (GvHD). Early pre-clinical studies suggested that intestinal microflora contribute to the pathogenesis of acute GvHD, and that growth suppression or eradication of intestinal bacteria prevented the development of acute GvHD even in MHC-mismatched transplants. These observations led to the practice of gut decontamination (GD) with oral non-absorbable antibiotics in patients undergoing allogeneic HSCT as a method of acute GvHD prophylaxis. Microbiome studies in the modern sequencing era are beginning to challenge the benefit of this practice. In this review, we provide a historical perspective on the practice of GD and highlight findings from the limited number of clinical trials evaluating the use of GD for acute GvHD prevention in allogeneic HSCT patients. In addition, we examine the role of the gut microbiota in allogeneic HSCT in the context of recent studies linking the microflora to regulation of intestinal immune homeostasis. We discuss the implications of these findings for future strategies to reduce acute GvHD risk by selective manipulation of the microbiota.
引用
收藏
页码:183 / 190
页数:8
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