Gut Microbiota in the Modulation of Outcomes after Liver Transplant

肝硬化是发病和死亡的主要原因，疾病进展与 改变肠道微生物的组成和功能。肝硬化唯一可靠的治疗方法是肝脏 移植（LT）。然而，相当一部分 LT 后患者出现多重耐药性 有机体（MDRO）、认知障碍和代谢综合征，这些可能会影响生命 威胁并导致长期残疾或 LT 前功能恢复不完全。 此外，使用目前可用的生物标志物，尚不清楚哪些患者会出现这些症状 LT 后不良事件，并且有一些证据表明肠道微生物群的改变起着重要作用 重要作用。该提案代表了使用 LT 前微生物调节的第一步 预防 LT 后并发症的中心假设是：肠道微生物组成 肝移植前的功能和功能可以成功预测移植后的结果。 我们将使用以下具体目标来研究这一假设： 目标 1：确定移植前肠道微生物组成和功能在 通过 MDRO 定植预测移植后感染， 目标 2：确定移植前肠道微生物组成和功能在 移植后代谢综合征的发展， 目标 3：确定移植前肠道微生物组成和功能在移植过程中的作用 肝移植后认知恢复 该研究将分为 2 部分： 第 1 部分将利用已从 150 LT 中收集的纵向样本 来自两个中心的接收者。第 2 部分将在每个中心再招募 50 名患者来验证研究结果 第 1 部分. 粪便微生物群组成（16srRNA 测序，了解多样性、相对丰度 潜在致病和有益类群，以及 MDRO 的特定分子检测 将进行定植）和功能（代谢组学、胆汁酸）。认知功能 （经过验证的纸笔和计算机技术）和代谢综合征将 LT 后诊断。移植前微生物评估将用于预测这些结果 独立于已经使用生物信息学验证的临床预测因子。这将有助于指导 未来基于微生物群的精准医学研究可预测 LT 患者。 VCU 和 CUIMC 的 CTSA 与拥有长期记录的领先 LT 中心相关 肝硬化、肝移植、微生物群和认知方面的临床和转化研究。两者都 中心将在招募和分析方面平等合作。该提案符合 PAR-19-100 通过关注人类微生物组的精准医学和转化研究。

Cirrhosis is a major cause of morbidity and mortality, and disease progression is associated with altered gut microbial composition and function. The only reliable cure for cirrhosis is liver transplant (LT). However, a sizable proportion of post-LT patients develop multi-drug resistant organisms (MDROs), cognitive impairment and metabolic syndrome, which can be life- threatening and result in long-term disability or incomplete recovery of pre-LT function. Moreover, using currently available biomarkers, it is unclear which patients will develop these post-LT adverse events and there is some evidence that altered gut microbiota plays an important role. This proposal represents the first step towards using pre-LT microbial modulation in preventing post-LT complications with the central hypothesis: Gut microbial composition and function before liver transplant can successfully predict post-transplant outcomes. We will study this hypothesis using the following specific aims: Aim 1: To determine the role of pre-transplant gut microbial composition and function in the prediction of post-transplant infections through MDRO colonization, Aim 2: To determine the role of pre-transplant gut microbial composition and function in the development of post-transplant metabolic syndrome, Aim 3: To determine the role of pre-transplant gut microbial composition and function in cognitive recovery after liver transplant The study will have 2 parts: Part 1 will utilize already collected longitudinal samples from 150 LT recipients from both centers. Part 2 will enroll 50 more patients per site to validate findings from part 1. Stool microbiota composition (16srRNA sequencing for diversity, relative abundance of potentially pathogenic and beneficial taxa, and specific molecular assays for MDRO colonization) and function (metabolomics, bile acids) will be performed. Cognitive function (validated paper-pencil and computerized techniques) and metabolic syndrome will be diagnosed post-LT. Pre-transplant microbial assessment will be used to predict these outcomes independent of already validated clinical predictors using bio-informatics. This will help guide future precision medicine based research on microbiota in prognosticating LT patients. The CTSAs at VCU and CUIMC are associated with leading LT centers with a long track record of clinical and translational research in cirrhosis, liver transplant, microbiota, and cognition. Both centers will collaborate equally in recruitment and analysis. This proposal fits with PAR-19-100 through the focus on Precision Medicine and Translational studies of the human microbiome.