Pilot Project 2: Social Correlates of Variation in Intestinal and Oral Microbiome Among Hematopoietic Stem Cell Transplant Patients: A Geographic Exploration in the City of Chicago

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ABSTRACT There is increasing evidence that low levels of human intestinal microbiome diversity are associated with differential survival outcomes for various malignancies, with low levels of microbiome diversity associated with poorer outcomes. Amongst hematopoietic stem cell transplant patients, microbiome diversity is associated with risk of infection, disease relapse, and the development of graft vs. host disease. This has led to research on the effects of diet and antibiotic usage, which have been implicated in microbiome composition. Stem cell transplant patients from ethnic/racial minority groups and low socioeconomic status families have inferior survival outcomes relative to the general population. Insured status, socioeconomic and sociocultural factors may play a role in these disparate outcomes. One biomarker that may closely track these characteristics is the intestinal microbiome. This potentially clinically important biomarker, which has recently been benchmarked to the Shannon-Weaver diversity standards, has not been explored or compared among socially diverse patient populations. There has been little attention to psychosocial or neighborhood level environments that are proving to be of such importance in the social epidemiology of cancer. This Chicago Cancer Health Equity Collaborative (ChicagoCHEC) pilot research project is designed to lay the groundwork for an ecological analysis of variation in microbiome diversity. A large, diverse, and segregated city like Chicago has known disparate outcomes in various malignancies, and is an ideal urban center to explore the role of geographic variation in gut microbiome diversity. ChicagoCHEC community engaged research has laid the groundwork for successful patient recruitment through our affiliated medical centers, and the study team is in a strong position to undertake this pilot study as part of a larger microbiome research program. We propose an innovative, multi-institutional, prospective study evaluating serial changes in intestinal and oral gut microbiota amongst 50 hematopoietic stem cell transplant patients selected from two widely diverse areas that are each characteristic of large populations in the Chicago metropolitan area. The study will demonstrate the feasibility of analyzing the association of microbiome diversity with early clinical outcomes amongst stem cell transplant patients residing in the Chicago area. These findings are expected to better elucidate the role that area characteristics, as reflected by geographic location, may play in intestinal gut microbiome diversity.