Análise da microbiota intestinal em paciente com doença de Crohn pré e pós-transplante de medula óssea

Abstract

Due to the importance of intestinal microbiota in the pathogenesis of inflammatory bowel diseases, such as Crohn's disease, therapies that manipulate the microbiota have been investigated, including the use of probiotics and prebiotics, with variable evidence for their efficacy. Hematopoietic stem cell transplantation can be used as an important treatment resource for Crohn's disease. After the procedure, the patient reestablishes the disease, as if the history of the disease is resumed, returning to the state before its onset. The microbiota can accompany this improvement since a profile is expected during the disease and can be reestablished after the procedure. Objective: The aim of this study was to evaluate the microbiota of a patient pre and post hematopoietic precursor cell transplantation (TCPH), seeking data on the microbiota of a sick patient before TCPH and a patient in deep remission after transplantation. Methodology: For clinical analysis, identification of donor bacteria was performed prior to transplantation, followed by stool collection prior to TCPH, 9 months after transplantation. The clinical severity of Crohn's disease was assessed by IADC. For molecular analysis, DNA extraction from the patient's stool was performed, followed by cloning of the 16S rRNA library, DNA sequencing, and phylogenetic analysis. For data analysis, absolute and relative frequency calculations were used, and parametric and / or nonparametric tests considering p <0.05 for significant values. Results: After TCPH, there was a change in the intestinal microbiota of the patient of the present study, mainly in the increase of bacteria of the genera Bacteroides, Prevotella, Ruminococcus, Blautia, Faecalibacterium, Parabacteroides, Oscillospira, Veillonella and Eubacterium. In addition, the important indicator of intestinal microbiota health was the summed percentage of Firmicutes and Bacteroidetes (F + B) in relation to the total, whose normal range should be between 85% and 95%. In this sequencing, the F + B indicator was within the desirable range after TCPH. Results also include statistically significant differences between all taxonomic comparisons within each taxonomic level (“Before” vs. “After”), with p <0.05 for nonparametric data. Conclusion: The present study demonstrated the importance of microbiota investigation in Crohn's disease, as the exact etiology of these diseases is not yet fully understood. Thus, there was a better microbiota composition after TCPH leading to a discussion of whether the disease activity leads to a microbiota change or whether its improvement is related to the outcome of the procedure or the TCPH result can be more stable.