Fecal microbiota transplantation in capsules for the treatment of steroid refractory and steroid dependent acute graft vs. host disease: a pilot study.
Fecal microbiota transplantation in capsules for the treatment of steroid refractory and steroid dependent acute graft vs. host disease: a pilot study.
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胶囊中粪便微生物移植用于治疗类固醇难治性和类固醇依赖性急性移植物抗宿主病：一项试点研究。
DOI：
10.1038/s41409-024-02198-2
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发表时间：
2024
影响因子：
4.8
通讯作者：
Nagler,Arnon
中科院分区：
文献类型：
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作者：
Youngster,Ilan;Eshel,Adi;Geva,Mika;Danylesko,Ivetta;Henig,Israel;Zuckerman,Tsila;Fried,Shalev;Yerushalmi,Ronit;Shem-Tov,Noga;Fein,JoshuaA;Bomze,David;Shimoni,Avichai;Koren,Omry;Shouval,Roni;Nagler,Arnon
急性移植物抗宿主病（aGvHD）是同种异体造血干细胞移植的严重并发症，治疗方案有限。肠道微生物组在aGvHD发病机制中起关键作用。粪便微生物群移植（FMT）已成为恢复肠道微生物多样性的潜在治疗方法。在这项前瞻性先导研究中，21例类固醇耐药或类固醇依赖性下消化道aGvHD患者接受了胶囊形式的FMT治疗。在第一次FMT后28天，总体缓解率为52.4%，其中完全缓解率为23.8%，部分缓解率为28.6%。然而，持续的反应并不常见，只有一名患者长期无agvhd。FMT一般耐受良好。微生物组分析显示，与供体相比，fmt前患者粪便样本具有明显的微生物特征。FMT后，有益梭菌增加，致病性肠杆菌减少。这些发现突出了FMT作为类固醇抵抗性aGvHD治疗选择的潜力。试验注册号NCT #03214289。
Acute graft-versus-host disease (aGvHD) is a serious complication of allogeneic hematopoietic stem-cell transplantation with limited treatment options. The gut microbiome plays a critical role in aGvHD pathogenesis. Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic approach to restore gut microbial diversity. In this prospective pilot study, 21 patients with steroid-resistant or steroid-dependent lower gastrointestinal aGvHD received FMT in capsule form. At 28 days after the first FMT, the overall response rate was 52.4%, with 23.8% complete and 28.6% partial responses. However, sustained responses were infrequent, with only one patient remaining aGvHD-free long-term. FMT was generally well-tolerated. Microbiome analysis revealed dysbiosis in pre-FMT patient stool samples, with distinct microbial characteristics compared to donors. Following FMT, there was an increase in beneficial Clostridiales and a decrease in pathogenic Enterobacteriales. These findings highlight the potential of FMT as a treatment option for steroid-resistant aGvHD. Trial registration number NCT #03214289.