Fecal microbiota transplantation in the treatment of astrovirus infection in a recipient of an allogeneic hematopoietic stem cell transplant: a clinical case
- Authors: Bespyatykh J.A.1,2,3, Gospodarik A.V.1, Zhuravel E.A.4, Seregin G.Z.4, Komarova A.V.1,3, Esiev S.S.1, Bronin G.O.4, Shansky Y.D.1
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Affiliations:
- Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
- N.A. Semashko National Research Institute of Public Health
- Mendeleev University of Chemical Technology of Russia
- Morozov Children's Municipal Clinical Hospital
- Issue: Vol 14, No 1 (2023)
- Pages: 115-122
- Section: Case reports
- URL: https://journals.rcsi.science/clinpractice/article/view/142812
- DOI: https://doi.org/10.17816/clinpract275406
- ID: 142812
Cite item
Abstract
Background: Secondary immunodeficiency in recipients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the pediatric practice is often accompanied by bacterial and viral infections of the gastrointestinal tract (GIT), resistant to conventional therapy. Fecal microbiota transplantation (FMT) promotes intestinal recolonization and eradication of gastrointestinal symptoms.
Clinical case description: A 2.5-year-old patient underwent allo-HSCT from a haploidentical related donor (father) as a part of the treatment of acute myeloid leukemia. A month after the last procedure, diarrhea (up to 10 times a day) and abdominal pain appeared. The astrovirus RNA and Clostridium difficile toxin A were detected in the feces. The FMT was prescribed. After two FMT procedures, the intestinal syndrome leveled out, and the tests for the astrovirus RNA and clostridial toxins were negative. The content of cholic and, in particular, deoxycholic acids, as well as their conjugates with glycine and taurine, in the feces increased; the acetic acid content increased with a simultaneous decrease in the level of propionic acid, which indicates the restoration of the intestinal microbiota’s functional potential.
Conclusion: FMT contributes to the restoration of the normal intestinal microflora, the elimination of clostridial toxins, enteroinvasive E. coli and astrovirus infection in allo-HSCT recipients, as evidenced by the indicators of the intestinal microbiota activity, and can be used in allo-HSCT recipients with infections refractory to conventional therapy.
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##article.viewOnOriginalSite##About the authors
Julia A. Bespyatykh
Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine; N.A. Semashko National Research Institute of Public Health; Mendeleev University of Chemical Technology of Russia
Author for correspondence.
Email: JuliaBes@rcpcm.org
ORCID iD: 0000-0002-4408-503X
SPIN-code: 6003-9246
PhD, Associate Professor
Russian Federation, 1a Malaya Pirogovskaya street, 119435 Moscow; Moscow; MoscowAlina V. Gospodarik
Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
Email: alina.gospodaryk@rcpcm.org
PhD, Research Associate
Russian Federation, 1a Malaya Pirogovskaya street, 119435 MoscowEvgeny A. Zhuravel
Morozov Children's Municipal Clinical Hospital
Email: zhuravel_evgeniy93@yandex.ru
врач
Russian Federation, MoscowGeorge Z. Seregin
Morozov Children's Municipal Clinical Hospital
Email: jorggg@mail.ru
врач-детский онколог отд. трансплантации костного мозга и гемопоэтических стволовых клеток
Russian Federation, MoscowAnastacia V. Komarova
Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine; Mendeleev University of Chemical Technology of Russia
Email: komaanasta@yandex.ru
Junior Research Associate
Russian Federation, 1a Malaya Pirogovskaya street, 119435 Moscow; MoscowSulejman S. Esiev
Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
Email: kap20081@gmail.com
SPIN-code: 9593-2893
Russian Federation, 1a Malaya Pirogovskaya street, 119435 Moscow
Gleb O. Bronin
Morozov Children's Municipal Clinical Hospital
Email: gbronin@morozdgkb.ru
ORCID iD: 0000-0002-0694-3996
SPIN-code: 6485-2648
MD, PhD
Russian Federation, MoscowYaroslab D. Shansky
Lopukhin Federal Research and Clinical Center of Physical-Chemical Medicine
Email: yar.shansky@rcpcm.org
ORCID iD: 0000-0003-4672-2474
SPIN-code: 7640-5940
PhD, Research Associate
Russian Federation, 1a Malaya Pirogovskaya street, 119435 MoscowReferences
- Abdel‐Rahman ME, Mathew S, Al Thani AA, et al. Clinical manifestations associated with acute viral gastroenteritis pathogens among pediatric patients in Qatar. J Med Virol. 2021;93(8):4794–4804. doi: 10.1002/jmv.26859
- Dong N, Li ZR, Qin P, et al. Risk factors for Clostridioides difficile infection in children: A systematic review and meta-analysis. J Hosp Inf. 2022;(130):112–121. doi: 10.1016/j.jhin.2022.09.004
- Granado‐Villar D, Sautu CD, Granados A. Acute gastroenteritis. Pediatr Rev. 2012;33(11):487–495. doi: 10.1542/pir.33.11.487
- Голощапов О.В., Чухловин А.Б., Бакини Е.А., и др. Трансплантация фекальной микробиоты при реакции “трансплантат против хозяина” у детей и взрослых: методы, клинические эффекты, безопасность // Терапевтический архив. 2020. Т. 92, № 7. С. 43–54. [Goloshchapov OV, Chukhlovin AB, Bakina EA, et al. Fecal microbiota transplantation in the graft-versus-host reaction in children and adults: Methods, clinical effects, safety. Ther Arch. 2020;92(7):43–54. (In Russ).] doi: 10.26442/00403660.2020.07.000773
- Razizadeh MH, Pourrostami K, Kachooei A, et al. An annoying enteric virus: A systematic review and meta‐analysis of human astroviruses and gastrointestinal complications in children. Rev Med Virol. 2022;32(6):e2389. doi: 10.1002/rmv.2389
- Spindelboeck W, Schulz E, Uhl B, et al. Repeated fecal microbiota transplantations attenuate diarrhea and lead to sustained changes in the fecal microbiota in acute, refractory gastrointestinal graft-versus-host-disease. Haematologica. 2017;102(5):e210-e213. doi: 10.3324/haematol.2016.154351
- Mylonakis E, Ryan E, Calderwood S. Clostridium difficileassociated diarrhea. Arch Intern Med. 2001;161(4):525–533. doi: 10.1001/archinte.161.4.525
- Шанский Я.Д., Комарова А.В., Беспятых Ю.А. Применение метода высокоэффективной жидкостной хроматографии в сочетании с тандемной масс-спектрометрией для мониторинга содержания желчных кислот и их конъюгатов в организме человека // Материалы научно-практических конференций в рамках VIII Российского конгресса лабораторной медицины (РКЛМ 2022), сентябрь 5–9. Москва, 2022. [Shansky YaD, Komarova AV, Bespyatykh JA. Application of the method of high-performance liquid chromatography in combination with tandem mass spectrometry for monitoring the content of bile acids and their conjugates in the human body. In: Materials of scientific and practical conferences within the framework of the VIII Russian Congress of Laboratory Medicine (RKLM 2022), Sep, 5–9. Moscow; 2022. (In Russ).]
- Zhgun ES, Kislun YV, Kalachniuk TN, et al. [Evaluation of the levels of metabolites in feces of patients with inflammatory bowel diseases. (In Russ).] Biomed Khim. 2020;66(3):233–240. doi: 10.18097/PBMC20206603233
- Shi N, Li N, Duan X, Niu H. Interaction between the gut microbiome and mucosal immune system. Mil Med Res. 2017; 4:14. doi: 10.1186/s40779-017-0122-9
- Kelly CR, Ihunnah C, Fischer M, et al. Fecal microbiota transplant for treatment of clostridium difficile infection in immunocompromised patients. Am J Gastroenterol. 2014; 109:1065–1071. doi: 10.1038/AJG.2014.133
- Green JE, Davis JA, Berk M, et al. Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: A systematic review and meta-analysis. Gut Microbes. 2020;12(1):1854640. doi: 10.1080/19490976.2020.1854640
- Sebire NJ, Malone M, Shah N, et al. Pathology of astrovirus associated diarrhoea in a paediatric bone marrow transplant recipient. J Clin Pathology. 2004;57(9):1001–1003. doi: 10.1136/jcp.2004.017178
- Serrano-Villar S, Talavera-Rodríguez A, Gosalbes MJ, et al. Fecal microbiota transplantation in HIV: A pilot placebo-controlled study. Nat Commun 2021;12:1139. doi: 10.1038/s41467-021-21472-1
- Pereira G, Gomes L, Santos I. Fecal microbiota transplantation in puppies with canine parvovirus infection. J Veterinary Int Med. 2018;32(2):707–711. doi: 10.1111/JVIM.15072
- Wunderli W, Meerbach A, Guengoer T, et al. Astrovirus infection in hospitalized infants with severe combined immunodeficiency after allogeneic hematopoietic stem cell transplantation. PLoS One. 2011;6(11):e27483. doi: 10.1371/journal.pone.0027483
- Kamp KJ, Cain KC, Utleget A, et al. Bile acids and microbiome among individuals with irritable bowel syndrome and healthy volunteers. Biol Res Nurs. 2021;23(1):65–74. doi: 10.1177/1099800420941255
- Perino A, Demagny H, Velazquez-Villegas L, Schoonjans K. Molecular physiology of bile acid signaling in health, disease, and aging. Physiol Rev. 2021;101(2):683–731. doi: 10.1152/physrev.00049.2019
- Foley MH, O’Flaherty S, Barrangou R, Theriot CM. Bile salt hydrolases: Gatekeepers of bile acid metabolism and host-microbiome crosstalk in the gastrointestinal tract. PLoS Pathog. 2019;15(3):e1007581. doi: 10.1371/journal.ppat.1007581
- Mirzaei R, Afaghi A, Babakhani S, et al. Role of microbiota-derived short-chain fatty acids in cancer development and prevention. Biomed Pharmacother. 2021;139:111619. doi: 10.1016/j.biopha.2021.111619
- Parada Venegas D, de la Fuente MK, Landskron G, et al. Short-chain fatty acids (SCFAs)-mediated gut epithelial and immune regulation and its relevance for inflammatory bowel diseases. Front Immunol. 2019;10:277. doi: 10.3389/fimmu.2019.00277