Enterococcus: A Predictor of Ravaged Microbiota and Poor Prognosis after Allogeneic Hematopoietic Stem Cell Transplantation

Kusakabe, Shinsuke; Fukushima, Kentaro; Yokota, Takafumi; Hino, Akihisa; Fujita, Jiro; Motooka, Daisuke; Nakamura, Shota; Shibayama, Hirohiko; Kanakura, Yuzuru

doi:10.1016/j.bbmt.2020.01.019

Cited by 22 publications

(13 citation statements)

References 15 publications

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“…It has been demonstrated that increased abundance of the genus Enterococcus as detected using 16S rRNA sequencing, but not using stool culture techniques, was associated with poor survival in patients who underwent -allo-HSCT. 44 Little is known regarding the relationship between FMT and CMV reactivation and the impact of FMT on the intestinal mycobiome.…”

Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation in the treatment of intestinal steroid-resistant graft-versus-host disease: two case reports and a review of the literature

et al. 2020

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Acute graft-versus-host disease (aGvHD) reduces the efficiency and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT). In recent years, attempts have been made to transplant fecal microbiota from healthy donors to treat intestinal GvHD. This study presented two cases of patients undergoing allo-HSCT who were later selected for fecal microbiota transplantation (FMT). In the first patient, FMT resulted in the complete resolution of symptoms, whereas therapeutic efficacy was not achieved in the second patient. FMT eliminated drug-resistant pathogens, namely very drug-resistant Enterococcus spp., but not multidrug-resistant Acinetobacter baumannii or Candida spp. Further research is needed, particularly on the safety of FMT in patients with intestinal steroid-resistant GvHD and on the distant impact of transplanted microflora on the outcomes of allo-HSCT. FMT appears promising for the treatment of patients with steroid-resistant GvHD.

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Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation in the treatment of intestinal steroid-resistant graft-versus-host disease: two case reports and a review of the literature

et al. 2020

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“…38 In a large study from the MSKCC, very high abundance of a bacterial group, mainly composed of Eubacterium limosum, in pretransplant samples or the presence of this group in periengraftment samples was found to correspond to a decreased relapse risk, 59 once again emphasizing the association of the microbiome and T-cell immunity. Furthermore, in the study from the Osaka University, 54 Enterococcus relative abundance of ≥1% at 1 month posttransplant appeared to be indicative of poor OS, with a 2year survival of 83.9% for patients with relative abundance of Enterococcus <1% versus 47.6% for those in whom this parameter was ≥1%. It is noteworthy that none of the surviving patients at 1 year post-transplant displayed Enterococcus abundance higher than 1%, sug-gesting that this cutoff could serve as a prognosticator of a long-term outcome in this clinical setting.…”

Section: Is the Disrupted Microbiome In Allogeneic Hematopoietic Stemmentioning

confidence: 93%

“…It is noteworthy that none of the surviving patients at 1 year post-transplant displayed Enterococcus abundance higher than 1%, sug-gesting that this cutoff could serve as a prognosticator of a long-term outcome in this clinical setting. 54 The above evidence suggests that the microbiota changes before and during allo-HSCT are significantly associated with transplant complications and outcomes and might even serve as a predictive marker in this setting.…”

Section: Is the Disrupted Microbiome In Allogeneic Hematopoietic Stemmentioning

confidence: 98%

“…53 Moreover, in some patients, microbiota has remained disrupted even 1 year after HSCT, this being particularly the case with butyrate-producing bacteria and Bifidobacterium. 54 Eventually, the effect of environmental insult on the intestinal microbiota during allo-HSCT can be so severe that its recovery may require a long time.…”

Section: What Is the Microbiome Status During The Transplantation Permentioning

confidence: 99%

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The clinical role of the gut microbiome and fecal microbiota transplantation in allogeneic stem cell transplantation

2020

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Outcomes of allogeneic hematopoietic stem cell transplantation (allo- HSCT) have improved in the recent decade; however, infections and graft-versus-host disease remain two leading complications significantly contributing to early transplant-related mortality. In past years, the human intestinal microbial composition (microbiota) has been found to be associated with various disease states, including cancer, response to cancer immunotherapy and to modulate the gut innate and adaptive immune response. In the setting of allo-HSCT, the intestinal microbiota diversity and composition appear to have an impact on infection risk, mortality and overall survival. Microbial metabolites have been shown to contribute to the health and integrity of intestinal epithelial cells during inflammation, thus mitigating graft-versus-host disease in animal models. While the cause-andeffect relationship between the intestinal microbiota and transplant-associated complications has not yet been fully elucidated, the above findings have already resulted in the implementation of various interventions aiming to restore the intestinal microbiota diversity and composition. Among others, these interventions include the administration of fecal microbiota transplantation. The present review, based on published data, is intended to define the role of the latter approach in the setting of allo-HSCT.

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“…Bacteroides fragilis ranks rst in clinical anaerobic bacteria isolation, accounts for up to 20%. When the intestinal mucosa of the host is damaged, Bacteroides fragilis heterotopic becomes an opportunistic pathogen, causing purulent infection of various organs of the body, such as intestine, abdominal cavity, liver, lung, and brain, accompanied by abscess and acute and chronic diarrhea (39). Bacteroides fragilis can secrete enterotoxins, make the adhesion and connection between the cells of human colon epithelial cell line HT29 / C1 disappear, round, and swell the cells.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Gut Microbiome and Prediction of Infection in Neutropenic Children with Acute Leukemia

Wang

et al. 2020

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Background: Neutropenia in children with acute leukemia have a high incidence of infection and mortality. To identify and classify the potentially infected pathogens, this study compared the structural characteristics of gut microbiome in neutropenic and non-neutropenic children with acute leukemia. Results: The results showed that 6033 OUTs were observed in total, and the sequence coverage index was more than 0.97. In the analysis of alpha diversity, the colony richness index (Chao1 index) of Group A1 was significantly lower than that of Group A0 (P = 0.035). The fecal bacterial communities were dominated by the phylum Firmicutes, Proteobacteria, and Bacteroidetes in both groups, with no significant difference. Higher relative abundance of genera Enterococcus (P = 0.0076), Streptococcus (P = 0.014) and species Bacteroides fragilis (P = 0.034) were observed in Group A1, but class Clostridia (P = 0.038), genera Blautia (P = 0.021) and Roseburia (P = 0.011) were more prevalent in Group A0. The relatively high abundance of Bacteroides fragilis in neutropenia with childhood acute leukemia was an independent risk factor for infection (P=0.028, 95% CI 1.024-1.241).Conclusions: The increase of Enterococcus, Streptococcus and Bacteroides fragilis, and the decrease of Clostridium, Blautia, and Roseburia may be the characteristics of intestinal flora in patients with acute leukemia. The relatively high abundance of Bacteroides fragilis in neutropenia with childhood acute leukemia may predict the occurrence of infection.

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Enterococcus: A Predictor of Ravaged Microbiota and Poor Prognosis after Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 22 publications

References 15 publications

Fecal microbiota transplantation in the treatment of intestinal steroid-resistant graft-versus-host disease: two case reports and a review of the literature

Fecal microbiota transplantation in the treatment of intestinal steroid-resistant graft-versus-host disease: two case reports and a review of the literature

The clinical role of the gut microbiome and fecal microbiota transplantation in allogeneic stem cell transplantation

Characteristics of Gut Microbiome and Prediction of Infection in Neutropenic Children with Acute Leukemia

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