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

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...

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Published in:	Blood 2015-10, Vol.126 (14), p.1723-1728
Main Authors:	Weber, Daniela, Oefner, Peter J., Hiergeist, Andreas, Koestler, Josef, Gessner, André, Weber, Markus, Hahn, Joachim, Wolff, Daniel, Stämmler, Frank, Spang, Rainer, Herr, Wolfgang, Dettmer, Katja, Holler, Ernst
Format:	Article
Language:	eng
Subjects:	Adult Aged Allografts Chromatography, Reverse-Phase Female Gastrointestinal Microbiome - physiology Genotype Graft vs Host Disease - genetics Graft vs Host Disease - microbiology Hematopoietic Stem Cell Transplantation - adverse effects Humans Indican - urine Kaplan-Meier Estimate Male Middle Aged Nod2 Signaling Adaptor Protein - genetics Proportional Hazards Models Prospective Studies Spectrometry, Mass, Electrospray Ionization
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Summary:	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 stem cell 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. •Urinary 3-IS levels predict outcome after ASCT and are associated with antibiotics and NOD2/CARD15 variants.
ISSN:	0006-4971 1528-0020