The effects of intestinal tract bacterial diversity on mortality following allogeneic hematopoietic stem cell transplantation
The effects of intestinal tract bacterial diversity on mortality following allogeneic hematopoietic stem cell transplantation
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DOI：
10.1182/blood-2014-02-554725
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发表时间：
2014-08-14
期刊：
影响因子：
20.3
通讯作者：
Pamer, Eric G.
中科院分区：
文献类型：
--
作者：
Taur, Ying;Jenq, Robert R.;Pamer, Eric G.
高度多样化的细菌种群栖息在胃肠道中，调节宿主炎症并促进免疫耐受。在异基因造血干细胞移植（allo-HSCT）中，胃肠道粘膜受损，定植细菌受到影响，导致肠道微生物群受损且多样性降低。我们研究了肠道多样性对移植后死亡率的影响。在干细胞植入时，从80名allo-HSCT受者收集粪便标本。细菌16 S rRNA基因序列的特点，和微生物多样性估计使用逆辛普森指数。受试者被分为高，中，低多样性组和评估的结果的差异。肠道多样性较低的患者死亡率显著更差;低、中和高多样性组的3年总生存率分别为36%、60%和67%（P= 0.019，对数秩检验）。在对其他临床预测因素进行多变量校正后，低多样性对死亡率有很强的影响（移植相关死亡率：校正风险比，5.25; P= 0.014）。总之，移植时肠道菌群的多样性是allo-HSCT受者死亡率的独立预测因子。这些结果表明，肠道菌群可能是allo-HSCT成功或失败的重要因素。
Highly diverse bacterial populations inhabit the gastrointestinal tract and modulate host inflammation and promote immune tolerance. In allogeneic hematopoietic stem cell transplantation (allo-HSCT), the gastrointestinal mucosa is damaged, and colonizing bacteria are impacted, leading to an impaired intestinal microbiota with reduced diversity. We examined the impact of intestinal diversity on subsequent mortality outcomes following transplantation. Fecal specimens were collected from 80 recipients of allo-HSCT at the time of stem cell engraftment. Bacterial 16S rRNA gene sequences were characterized, and microbial diversity was estimated using the inverse Simpson index. Subjects were classified into high, intermediate, and low diversity groups and assessed for differences in outcomes. Mortality outcomes were significantly worse in patients with lower intestinal diversity; overall survival at 3 years was 36%, 60%, and 67% for low, intermediate, and high diversity groups, respectively (P=.019, log-rank test). Low diversity showed a strong effect on mortality after multivariate adjustment for other clinical predictors (transplant related mortality: adjusted hazard ratio, 5.25; P=.014). In conclusion, the diversity of the intestinal microbiota at engraftment is an independent predictor of mortality in allo-HSCT recipients. These results indicate that the intestinal microbiota may be an important factor in the success or failure in allo-HSCT.