Safety and efficacy of fecal microbiota transplantation in the treatment of graft-versus-host disease

Qiao, Xiaoying; Biliński, Jarosław; Wang, Leyi; Yang, Tianyu; Luo, Rongmu; Fu, Yi; Yang, Glen

doi:10.1038/s41409-022-01824-1

Cited by 20 publications

(15 citation statements)

References 70 publications

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“…Conversely, administering probiotics could be remotely beneficial for replenishing the commensal microbiota to counteract intestinal dysbiosis. Promising results on the safety and efficacy of fecal microbiota transplantation in the treatment of GvHD sustain this hypothesis [26].…”

Section: Before the Stormmentioning

confidence: 95%

Nutritional interventions in patients with graft-versus-host disease

Séguy

Hueso

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review This review aims to highlight the benefits of nutrition before and during graft-versus-host disease (GvHD) and the promising precision medicine approach that should be offered to prevent and mitigate GvHD. Recent findings The intestinal damage induced by preconditioning/conditioning chemotherapies is the main trigger of GvHD. Impaired nutritional status and decreased plasma citrulline level, which is the most sensitive biomarker of intestinal barrier health, predict the occurrence of acute GvHD after allogeneic hematopoietic cell transplantation (allo-HCT). Optimal oral and/or enteral nutrition and a lack of vitamin D deficiency limit this intestinal damage. As intestinal dysbiosis plays an important role in GvHD, probiotics and prebiotics supplementation could be a promising therapy. Diverting enterostomy combined with parenteral nutrition saves the lives of patients with severe steroid-refractory gastrointestinal GvHD. Summary Regardless of age, healthy nutritional status and a healthy gut barrier are protective factors against GvHD in patients undergoing allo-HCT, and above all, these are closely dependent on adequate oral and/or enteral intake. Therefore, maintaining gut barrier integrity through adequate oral nutrition before allo-SCT and early first-line enteral nutrition after allo-HCT are of critical importance, not forgetting vitamin D supplementation. In the future, probiotics and prebiotics are expected to play a growing role for replenishing the commensal microbiota given the impact of gut dysbiosis on GvHD. Parenteral nutrition remains the only nutritional support that can be used in the event of severe gastrointestinal GvHD.

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Section: Before the Stormmentioning

confidence: 95%

Nutritional interventions in patients with graft-versus-host disease

Séguy

Hueso

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…Hematopoietic stem cell transplantation (HSCT) is used to treat a wide range of hematologic malignancies, and immunodeficiencies. One of the most serious complications of allogeneic HSCT is acute graft-versus-host disease (aGVHD), which causes high mortality and morbidity [61,62 ▪▪ ]. Increasingly, research suggests that aGVHD is closely linked to the gut microbiome [63–65].…”

Section: Dysbiosis and Human Diseasesmentioning

confidence: 99%

Gut microbiome and its clinical implications: exploring the key players in human health

Koneru,

Thiruvadi,

Ramesh

2023

Current Opinion in Infectious Diseases

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Purpose of review The human gut harbors a diverse community of microorganisms known as the gut microbiota. Extensive research in recent years has shed light on the profound influence of the gut microbiome on human health and disease. This review aims to explore the role of the gut microbiome in various clinical conditions and highlight the emerging therapeutic potential of targeting the gut microbiota for disease management. Recent findings Knowledge of the influence of gut microbiota on human physiology led to the development of various therapeutic possibilities such as fecal microbiota transplant (FMT), phage therapy, prebiotics, and probiotics. Recently, the U.S. FDA approved two FMT products for the treatment of recurrent Clostridioides difficile infection with ongoing research for the treatment of various disease conditions. Summary Advancement in the knowledge of the association between gut microbiota and various disease processes has paved the way for novel therapeutics.

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“…A meta-analysis recently evaluated the efficacy and safety of FMT for the treatment of SR-or SD-GI aGVHD. 87 This meta-analysis included 23 studies: 2 prospective cohort studies, 10 prospective single-arm studies, 2 retrospective single-arm studies, 2 case series, and 7 case reports. Among 242 patients, 100 achieved a CR, 61 a PR, and 81 had no response after FMT.…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

The Microbiome and Its Impact on Allogeneic Hematopoietic Cell Transplantation

Malard

Jenq

2023

Cancer J

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Allogeneic hematopoietic cell transplantation (alloHCT) is a standard curative therapy for a variety of benign and malignant hematological diseases. Previously, patients who underwent alloHCT were at high risk for complications with potentially life-threatening toxicities, including a variety of opportunistic infections as well as acute and chronic manifestations of graft-versus-host disease (GVHD), where the transplanted immune system can produce inflammatory damage to the patient. With recent advances, including newer conditioning regimens, advances in viral and fungal infection prophylaxis, and novel GVHD prophylactic and treatment strategies, improvements in clinical outcomes have steadily improved. One modality with great potential that has yet to be fully realized is targeting the microbiome to further improve clinical outcomes.In recent years, the intestinal microbiota, which includes bacteria, fungi, viruses, and other microbes that reside within the intestinal tract, has become established as a potent modulator of alloHCT outcomes. The composition of intestinal bacteria, in particular, has been found in large multicenter prospective studies to be strongly associated with GVHD, treatment-related mortality, and overall survival. Murine studies have demonstrated a causal relationship between intestinal microbiota injury and aggravated GVHD, and more recently, clinical interventional studies of repleting the intestinal microbiota with fecal microbiota transplantation have emerged as effective therapies for GVHD. How the composition of the intestinal bacterial microbiota, which is often highly variable in alloHCT patients, can modulate GVHD and other outcomes is not fully understood. Recent studies, however, have begun to make substantial headway, including identifying particular bacterial subsets and/or bacterial-derived metabolites that can mediate harm or benefit. Here, the authors review recent studies that have improved our mechanistic understanding of the relationship between the microbiota and alloHCT outcomes, as well as studies that are beginning to establish strategies to modulate the microbiota with the hope of optimizing clinical outcomes.

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Safety and efficacy of fecal microbiota transplantation in the treatment of graft-versus-host disease

Cited by 20 publications

References 70 publications

Nutritional interventions in patients with graft-versus-host disease

Nutritional interventions in patients with graft-versus-host disease

Gut microbiome and its clinical implications: exploring the key players in human health

The Microbiome and Its Impact on Allogeneic Hematopoietic Cell Transplantation

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