There is accumulating evidence that the lower airway microbiota impacts lung health.However, the link between microbial community composition and lung homeostasis remains elusive. We combined amplicon sequencing and culturomics to characterize the viable bacterial community in 234 longitudinal bronchoalveolar lavage samples from 64 lung transplant recipients and established links to viral loads, host gene expression, lung function, and transplant health. We find that the lung microbiota post-transplant can be categorized into four distinct compositional states, 'pneumotypes'. The predominant 'balanced' pneumotype was characterized by a diverse bacterial community with moderate viral loads, and host gene expression profiles suggesting immune tolerance. The other three pneumotypes were characterized by being either microbiota-depleted, or dominated by potential pathogens, and were linked to increased immune activity, lower respiratory function, and increased risks of infection and rejection. Collectively, our findings establish a link between the lung microbial ecosytem, human lung function, and clinical stability post-transplant.
Graphical abstract2015), we found that Bacteroidetes and Firmicutes followed by Proteobacteria and Actinobacteria are the most abundant phyla in the post-transplant lung (Figure 1B).Prevalence analysis across all BALF samples showed that the community composition is highly variable with only 22 OTUs shared by ≥50% of the samples (Figure S1B, Dataset S3).However, these 22 OTUs constituted 42 % of the total number of normalized reads, indicating that they are predominant members of the post-transplant lung microbiota (Figure 1C, Figure S1C, Table S2, Dataset S3). They belonged to the genera Prevotella7, Streptococcus, Porphyromonas and Rothia, the majority of which are also prevailing community members in completion of the clinical dataset, Julie Pernot for technical assistance, and the transplant patients for allowing their clinical data and BALF samples to be used for clinical research.