Hayase Eiko
The University of Texas MD Anderson Cancer Center, Department of Genomic Medicine.
Rinsho Ketsueki. 2024;65(9):1140-1147. doi: 10.11406/rinketsu.65.1140.
The intestinal microbiota is an important prognostic factor for allogeneic hematopoietic stem cell transplantation (allo-HCT), and decreased diversity of the intestinal microbiota is linked to shorter overall survival, high transplant-related mortality, and acute graft-versus-host disease (GVHD). Major factors that alter the intestinal microbiota during allo-HCT are broad-spectrum antibiotics and intestinal GVHD. Broad-spectrum antibiotics dysregulate the immune system and impair intestinal epithelial regeneration by reducing beneficial commensal bacteria and activating mucus-degrading bacteria, which disrupts the colonic barrier function. Intestinal GVHD leads to decreased secretion of antimicrobial peptides into the intestinal lumen, as well as mitochondrial dysfunction in the intestinal epithelium, altering the intestinal microbiota. Various therapeutic approaches targeting the intestinal microbiota have been investigated in clinical trials. Protecting the intestinal microbiota may further enhance the safety and efficacy of allo-HCT by regulating intestinal immune responses, promoting intestinal epithelial regeneration, and facilitating the production of beneficial metabolites derived from commensal bacteria.
肠道微生物群是异基因造血干细胞移植（allo-HCT）的一个重要预后因素，肠道微生物群多样性降低与总生存期缩短、高移植相关死亡率及急性移植物抗宿主病（GVHD）相关。allo-HCT期间改变肠道微生物群的主要因素是广谱抗生素和肠道GVHD。广谱抗生素通过减少有益共生菌和激活黏液降解菌来失调免疫系统并损害肠道上皮再生，这会破坏结肠屏障功能。肠道GVHD导致抗菌肽向肠腔分泌减少，以及肠道上皮细胞线粒体功能障碍，从而改变肠道微生物群。针对肠道微生物群的各种治疗方法已在临床试验中进行了研究。保护肠道微生物群可能通过调节肠道免疫反应、促进肠道上皮再生以及促进共生菌衍生的有益代谢产物的产生，进一步提高allo-HCT的安全性和疗效。
