Staffas Anna, Burgos da Silva Marina, van den Brink Marcel R M
Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Medicine and.
Blood. 2017 Feb 23;129(8):927-933. doi: 10.1182/blood-2016-09-691394. Epub 2016 Dec 9.
Hematopoietic cell transplantation (HCT) is a critical treatment of patients with high-risk hematopoietic malignancies, hematological deficiencies, and other immune diseases. In allogeneic HCT (allo-HCT), donor-derived T cells recognize host tissues as foreign, causing graft-versus-host disease (GVHD) which is a main contributor to morbidity and mortality. The intestine is one of the organs most severely affected by GVHD and research has recently highlighted the importance of bacteria, particularly the gut microbiota, in HCT outcome and in GVHD development. Loss of intestinal bacterial diversity is common during the course of HCT and is associated with GVHD development and treatment with broad-spectrum antibiotics. Loss of intestinal diversity and outgrowth of opportunistic pathogens belonging to the phylum Proteobacteria and genus have also been linked to increased treatment-related mortality including GVHD, infections, and organ failure after allo-HCT. Experimental studies in allo-HCT animal models have shown some promising results for prebiotic and probiotic strategies as prophylaxis or treatment of GVHD. Continuous research will be important to define the relation of cause and effect for these associations between microbiota features and HCT outcomes. Importantly, studies focused on geographic and cultural differences in intestinal microbiota are necessary to define applicability of new strategies targeting the intestinal microbiota.
造血细胞移植（HCT）是高危造血系统恶性肿瘤、血液系统缺陷及其他免疫疾病患者的关键治疗方法。在异基因造血细胞移植（allo-HCT）中，供体来源的T细胞将宿主组织识别为外来组织，引发移植物抗宿主病（GVHD），这是导致发病和死亡的主要原因。肠道是受GVHD影响最严重的器官之一，最近的研究强调了细菌，尤其是肠道微生物群，在造血细胞移植结果和移植物抗宿主病发展中的重要性。在造血细胞移植过程中，肠道细菌多样性的丧失很常见，并且与移植物抗宿主病的发展以及广谱抗生素治疗有关。肠道多样性的丧失以及属于变形菌门的机会性病原体的过度生长也与异基因造血细胞移植后包括移植物抗宿主病、感染和器官衰竭在内的治疗相关死亡率增加有关。在异基因造血细胞移植动物模型中的实验研究表明，益生元和益生菌策略作为移植物抗宿主病的预防或治疗方法具有一些有前景的结果。持续的研究对于确定微生物群特征与造血细胞移植结果之间这些关联的因果关系很重要。重要的是，有必要开展针对肠道微生物群地理和文化差异的研究，以确定针对肠道微生物群的新策略的适用性。
