Andersen Sarah, Kennedy Glen, Banks Merrilyn, Flanagan Bernadine, Henden Andrea
Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
Blood Adv. 2025 Aug 26;9(16):4167-4179. doi: 10.1182/bloodadvances.2024015703.
The decline in diversity of the gastrointestinal microbiome during hematopoietic stem cell transplantation (HSCT) is associated with poorer clinical outcomes. Although provision of enteral nutrition (EN) is common during HSCT, provision of a prebiotic fiber-containing formula has not been explored. This pilot study compared tolerance, clinical, microbiome, and metabolomic outcomes between patients who received standard EN (n = 10) vs prebiotic fiber EN (n = 20) after allogeneic HSCT. Stool samples were collected at baseline and at periengraftment and were analyzed with shotgun metagenomic sequencing. Provision of prebiotic EN increased daily fiber intake after transplant to an average 22 g/d compared with 4 g/d in the standard-care group. High tolerance of both EN formulas was observed with only 20% (n = 2) of the standard and 15% of the prebiotic group (n = 3) requiring parenteral nutrition (P = 1.0). There was no difference in the amount of EN provided, EN duration, or clinical outcomes. Microbial diversity declined in both groups with no difference post-EN provision (P = .93), however, there was a significant difference in relative abundance of Lactobacillus_C rhamnosus, with an increase in the prebiotic group only (P = .022). The relative abundance of Faecalicatena gnavus increased in the standard group and declined in the prebiotic group (P = .0027). Functional analysis of the microbial genome showed decreased expression of antibiotic resistance genes in the prebiotic group only after EN provision (P = .00035). A longer fiber intervention should be trialed to optimize clinical outcomes and a more diverse microbiome. The trial was registered at www.anzctr.org.au as #ACTRN12621000832875.
造血干细胞移植（HSCT）期间胃肠道微生物群多样性的下降与较差的临床结局相关。尽管在HSCT期间提供肠内营养（EN）很常见，但含益生元纤维配方的肠内营养尚未得到研究。这项前瞻性研究比较了接受标准EN（n = 10）与接受益生元纤维EN（n = 20）的异基因HSCT患者的耐受性、临床、微生物群和代谢组学结局。在基线和植入前后收集粪便样本，并用鸟枪法宏基因组测序进行分析。与标准护理组平均每天4克的纤维摄入量相比，提供益生元EN使移植后每日纤维摄入量增加到平均22克/天。观察到两种EN配方的耐受性都很高，标准组只有20%（n = 2），益生元组只有15%（n = 3）需要肠外营养（P = 1.0）。提供的EN量、EN持续时间或临床结局没有差异。两组的微生物多样性均下降，提供EN后无差异（P = 0.93），然而，鼠李糖乳杆菌的相对丰度有显著差异，仅益生元组增加（P = 0.022）。标准组中纤细粪球菌的相对丰度增加，而益生元组中则下降（P = 0.0027）。微生物基因组的功能分析显示，仅在提供EN后，益生元组中抗生素抗性基因的表达下降（P = 0.00035）。应该尝试更长时间的纤维干预，以优化临床结局和更丰富的微生物群。该试验在www.anzctr.org.au上注册，注册号为#ACTRN12621000832875。
