文章：

异基因造血干细胞移植中肠道微生物群的损伤

Gut microbiota injury in allogeneic haematopoietic stem cell transplantation

原文发布日期：2018-02-16

DOI: 10.1038/nrc.2018.10

类型: Review Article

开放获取: 否

要点：

1. Allogeneic haematopoietic stem cell transplantation (allo-HSCT) offers the strongest anticancer therapy for many malignancies but has limited application owing to complications including graft-versus-host disease (GVHD), infections and relapse. Understanding the microbiota ecology in these settings will help to develop better strategies to overcome these complications.
2. Recent advances in large-scale DNA sequencing technology enable thorough evaluation of changes in microbiota in patients undergoing allo-HSCT, and evidence is starting to accumulate with regard to beneficial and harmful changes in microbiota in the setting of allo-HSCT.
3. Loss of microbiota diversity after allo-HSCT is associated with worse GVHD and mortality after allo-HSCT.
4. Faecal microbiota transfer (FMT) may be beneficial to restore a microbiota that has been injured. It potentially improves GVHD and prevents infectious complications after allo-HSCT.
5. Broad-spectrum antibiotic use can lead to microbiota injury and increases GVHD-related mortality after allo-HSCT.
6. To develop novel strategies to improve outcomes following allo-HSCT, better characterization of the changes in the microbiota after allo-HSCT should be performed in a prospective multicentre fashion.

要点翻译：

1. 异基因造血干细胞移植（allo-HSCT）为许多恶性肿瘤提供了最强的抗癌治疗，但由于包括移植物抗宿主病（GVHD）、感染和复发在内的并发症，其应用受到限制。理解这些情况下的微生物群生态将有助于制定更好的策略来克服这些并发症。
2. 大规模DNA测序技术的最新进展使得能够全面评估接受allo-HSCT的患者微生物群的变化，并且关于allo-HSCT背景下有益和有害微生物群变化的证据开始积累。
3. allo-HSCT后微生物群多样性的丧失与更严重的GVHD和移植后死亡率相关。
4. 粪便微生物群移植（FMT）可能有助于恢复受损的微生物群。它有可能改善GVHD并预防allo-HSCT后的感染并发症。
5. 广谱抗生素的使用可能导致微生物群损伤，并增加allo-HSCT后与GVHD相关的死亡率。
6. 为了开发改善allo-HSCT后结局的新策略，应以前瞻性多中心方式对allo-HSCT后微生物群的变化进行更好的表征。

英文摘要：

Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is considered to be the strongest curative immunotherapy for various malignancies (primarily, but not limited to, haematologic malignancies). However, application of allo-HSCT is limited owing to its life-threatening major complications, such as graft-versus-host disease (GVHD), relapse and infections. Recent advances in large-scale DNA sequencing technology have facilitated rapid identification of the microorganisms that make up the microbiota and evaluation of their interactions with host immunity in various diseases, including cancer. This has resulted in renewed interest regarding the role of the intestinal flora in patients with haematopoietic malignancies who have received an allo-HSCT and in whether the microbiota affects clinical outcomes, including GVHD, relapse, infections and transplant-related mortality. In this Review, we discuss the potential role of intestinal microbiota in these major complications after allo-HSCT, summarize clinical trials evaluating the microbiota in patients who have received allo-HSCT and discuss how further studies of the microbiota could inform the development of strategies that improve outcomes of allo-HSCT.

摘要翻译： 

异基因造血干细胞移植（allo-HSCT）被视为治疗多种恶性肿瘤（主要是但不限于血液系统恶性肿瘤）最有力的根治性免疫疗法。然而，allo-HSCT的应用因其危及生命的严重并发症而受到限制，例如移植物抗宿主病（GVHD）、复发和感染。大规模DNA测序技术的最新进展促进了微生物群的快速鉴定，并评估了其在包括癌症在内的多种疾病中与宿主免疫的相互作用。这重新引起了人们对肠道菌群在接受allo-HSCT的血液系统恶性肿瘤患者中的作用以及微生物群是否影响包括GVHD、复发、感染和移植相关死亡率在内的临床结局的兴趣。在本综述中，我们讨论了肠道微生物群在allo-HSCT后这些主要并发症中的潜在作用，总结了在接受allo-HSCT的患者中评估微生物群的临床试验，并讨论了微生物群的进一步研究如何为制定改善allo-HSCT结局的策略提供信息。

原文链接：

Gut microbiota injury in allogeneic haematopoietic stem cell transplantation