Muratore Edoardo, Leardini Davide, Baccelli Francesco, Venturelli Francesco, Prete Arcangelo, Masetti Riccardo
Pediatric Oncology and Hematology "Lalla Seràgnoli," IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
Front Nutr. 2022 Oct 20;9:993668. doi: 10.3389/fnut.2022.993668. eCollection 2022.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents a potentially curative strategy for many oncological and non-oncological diseases, but it is associated with marked morbidity and mortality. The disruption of gut microbiota (GM) eubiosis has been linked to major allo-HSCT complications, including infections and acute graft vs. host disease (aGvHD), and correlates with mortality. This increasing knowledge on the role of the GM in the allo-HSCT procedure has led to fascinating ideas for modulating the intestinal ecosystem in order to improve clinical outcomes. Nutritional strategies, either by changing the route of nutritional supplementation or by administering specific molecules, are increasingly being considered as cost- and risk-effective methods of modulating the GM. Nutritional support has also emerged in the past several years as a key feature in supportive care for allo-HSCT recipients, and deterioration of nutritional status is associated with decreased overall survival and higher complication rates during treatment. Herein we provide a complete overview focused on nutritional modulation of the GM in allo-HSCT recipients. We address how pre transplant diet could affect GM composition and its ability to withstand the upsetting events occurring during transplantation. We also provide a complete overview on the influence of the route of nutritional administration on the intestinal ecosystem, with a particular focus on the comparison between enteral and parenteral nutrition (PN). Moreover, as mounting evidence are showing how specific components of post-transplant diet, such as lactose, could drastically shape the GM, we will also summarize the role of prebiotic supplementation in the modulation of the intestinal flora and in allo-HSCT outcomes.
异基因造血干细胞移植（allo-HSCT）是治疗多种肿瘤和非肿瘤疾病的一种潜在治愈性策略，但它伴随着显著的发病率和死亡率。肠道微生物群（GM）微生态的破坏与allo-HSCT的主要并发症有关，包括感染和急性移植物抗宿主病（aGvHD），并与死亡率相关。对GM在allo-HSCT过程中作用的认识不断增加，引发了关于调节肠道生态系统以改善临床结果的有趣想法。营养策略，无论是通过改变营养补充途径还是通过给予特定分子，越来越被认为是调节GM的具有成本效益和风险效益的方法。在过去几年中，营养支持也已成为allo-HSCT受者支持性护理的一个关键特征，营养状况恶化与治疗期间总体生存率降低和并发症发生率升高相关。在此，我们提供了一个全面的概述，重点关注allo-HSCT受者中GM的营养调节。我们探讨移植前饮食如何影响GM组成及其抵御移植期间发生的干扰事件的能力。我们还全面概述了营养给药途径对肠道生态系统的影响，特别关注肠内营养和肠外营养（PN）之间的比较。此外，由于越来越多的证据表明移植后饮食的特定成分，如乳糖，如何能极大地塑造GM，我们还将总结益生元补充在调节肠道菌群和allo-HSCT结果中的作用。
