Low urinary indoxyl sulfate levels early after transplantation reflect a disrupted microbiome and are associated with poor outcome

Weber, Daniela and Oefner, Peter J. and Hiergeist, Andreas and Koestler, Josef and Gessner, Andre and Weber, Markus and Hahn, Joachim and Wolff, Daniel and Staemmler, Frank and Spang, Rainer and Herr, Wolfgang and Dettmer, Katja and Holler, Ernst (2015) Low urinary indoxyl sulfate levels early after transplantation reflect a disrupted microbiome and are associated with poor outcome. BLOOD, 126 (14). pp. 1723-1728. ISSN 0006-4971, 1528-0020

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Abstract

Indole, which is produced from L-tryptophan by commensal bacteria expressing tryptophanase, not only is an important intercellular signal in microbial communities, but also modulates mucosal barrier function and expression of pro-and anti-inflammatory genes by intestinal epithelial cells. Here, we hypothesized that decreased urinary excretion of 3-indoxyl sulfate (3-IS), the major conjugate of indole found in humans, may be a marker of gut microbiota disruption and increased risk of developing gastrointestinal (GI) graft-versus-host-disease. Using liquid chromatography/tandem mass spectrometry, 3-IS was determined in urine specimens collected weekly within the first 28 days after allogeneic stemcell transplantation (ASCT) in 131 patients. Low 3-IS levels within the first 10 days after ASCT were associated with significantly higher transplant-related mortality (P = .017) and worse overall survival (P = .05) 1 year after ASCT. Least absolute shrinkage and selection operator regression models trained on log-normalized counts of 763 operational taxonomic units derived from next-generation sequencing of the hypervariable V3 region of the 16S ribosomal RNA gene showed members of the families of Lachnospiraceae and Ruminococcaceae of the class of Clostridia to be associated with high urinary 3-IS levels, whereas members of the class of Bacilli were associated with low 3-IS levels. Risk factors of early suppression of 3-IS levels were the type of GI decontamination(P = .01), early onset of antibiotic treatment (P = .001), and recipient NOD2/CARD15 genotype (P = .04). In conclusion, our findings underscore the relevance of microbiota-derived indole and metabolites thereof in mucosal integrity and protection from inflammation.

Item Type: Article
Uncontrolled Keywords: STEM-CELL TRANSPLANTATION; VERSUS-HOST-DISEASE; CROHNS-DISEASE; DIVERSITY; INDOLE; INFLAMMATION; ANTIBIOTICS; HOMEOSTASIS; METABOLITES; MORTALITY;
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Institut für Funktionelle Genomik > Lehrstuhl für Funktionelle Genomik (Prof. Oefner)
Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie)
Medicine > Lehrstuhl für Medizinische Mikrobiologie und Hygiene
Medicine > Lehrstuhl für Orthopädie
Medicine > Institut für Funktionelle Genomik > Lehrstuhl für Statistische Bioinformatik (Prof. Spang)
Depositing User: Dr. Gernot Deinzer
Date Deposited: 06 Jun 2019 07:48
Last Modified: 06 Jun 2019 07:48
URI: https://pred.uni-regensburg.de/id/eprint/4660

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