Soleimani Samarkhazan Hamed, Nouri Sina, Maleknia Mohsen, Aghaei Mojtaba
Student Research Committee, Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Immunology, Faculty of medicine, Tabriz university of medical science, Tabriz, Iran.
J Transl Med. 2025 Jul 25;23(1):832. doi: 10.1186/s12967-025-06797-5.
Graft-versus-host disease (GVHD), a life-threatening complication of allogeneic hematopoietic stem cell transplantation (HSCT), is shaped by a dynamic interplay between two microbial ecosystems: the recipient's disrupted microbiome and the donor's transplanted microbiota. This narrative review unravels the "tale of two ecosystems," exploring how pre-transplant chemotherapy, radiation, and antibiotics induce recipient dysbiosis-marked by loss of beneficial taxa (Clostridia, Faecalibacterium) and dominance of pathobionts (Enterococcus). These shifts impair barrier integrity, fuel systemic inflammation, and skew immune responses toward pro-inflammatory T-cell subsets, exacerbating GVHD. Conversely, emerging evidence implicates donor microbiota in modulating post-transplant immune reconstitution, though its role remains underexplored. Therapeutic strategies, including probiotics, prebiotics, and fecal microbiota transplantation (FMT), demonstrate promise in restoring microbial balance, enhancing short-chain fatty acid (SCFA)-driven immune regulation, and reducing GVHD severity. However, challenges such as strain-specific efficacy, safety in immunocompromised hosts, and protocol standardization persist. By bridging microbial ecology and immunology, this review underscores the microbiome's transformative potential in redefining GVHD management and advocates for personalized, microbiome-targeted interventions to improve HSCT outcomes.
移植物抗宿主病（GVHD）是同种异体造血干细胞移植（HSCT）的一种危及生命的并发症，它由两种微生物生态系统之间的动态相互作用所塑造：受者被破坏的微生物群和供者移植的微生物群。这篇叙述性综述揭示了“两个生态系统的故事”，探讨了移植前化疗、放疗和抗生素如何诱发受者生态失调，其特征是有益菌群（梭菌属、粪杆菌属）减少和致病共生菌（肠球菌）占主导地位。这些变化损害屏障完整性，加剧全身炎症，并使免疫反应偏向促炎性T细胞亚群，从而加重GVHD。相反，新出现的证据表明供者微生物群在调节移植后免疫重建中起作用，但其作用仍未得到充分探索。治疗策略，包括益生菌、益生元及粪便微生物群移植（FMT），在恢复微生物平衡、增强短链脂肪酸（SCFA）驱动的免疫调节及降低GVHD严重程度方面显示出前景。然而，诸如菌株特异性疗效、免疫受损宿主的安全性及方案标准化等挑战依然存在。通过将微生物生态学与免疫学联系起来，本综述强调了微生物群在重新定义GVHD管理方面的变革潜力，并倡导采用个性化的、以微生物群为靶点的干预措施来改善HSCT结局。
