Gut microbiota may affect CAR-T outcome, but further research is needed

Previous studies have shown that antibiotic use may be associated with poor outcomes in patients with blood cancers treated with CAR-T cell therapy, but more recent studies experts explained that there are too many potential factors besides the use of antibiotics. contribute to these results.

“If you look at a patient who’s been given antibiotics and want to identify the impact of the microbiome, there’s no good way to do that, because it’s confounded by all these other factors,” study author Dr. Michael said. says. His Jain, associate member of the Department of Blood and Bone Marrow Transplantation and Cellular Immunotherapy at Moffitt Cancer Center in Tampa, Fla., said in an interview with CURE®:

Jain and his colleagues at Moffitt, University of Texas MD Anderson Cancer Center, reported that the gut microbiome (dramatically altered by possible) were analyzed. Houston, or two other hospitals in Germany.

Their findings showed that patients who received broad-spectrum antibiotics prior to CAR-T cell therapy tended to have less microbiome diversity and worse treatment outcomes. The findings may also be driven by the fact that groups of patients who received antibiotics tended to have higher tumor burdens and more suppressed immune systems.

“What we found in this multi-center[study]was that, indeed, patients who received antibiotics had significantly altered (and) dysregulated microbiomes after receiving antibiotics. “But they were also patients who had a very high tumor burden and a dysfunctional immune system. They were probably the first to get an infection that required antibiotics.” That’s why I got infected.”

Of note, CAR-T cell therapy is an immune-driven therapy for non-Hodgkin’s lymphoma and other hematologic malignancies. This involves taking a patient’s immune (T) cells, engineering them to find and fight cancer, and injecting them into the patient. According to the National Institutes of Health, the gut microbiome that lives in the gut plays a key role in controlling when immune cells should be activated, so the gut microbiome also plays a role in the immune system. plays. This is a concept known as “immune homeostasis”. ”

“One of the biggest interfaces between our immune system and what we call antigens, or things that are foreign to us, are all the bacteria that live in our bodies,” Jain said. explained.

Because of these other factors that may influence the outcome of CAR-T cell therapy, the investigators in this study did not recommend that patients receive antibiotic-naive or low-risk antibiotics prior to treatment. They found that patients with higher levels of Bifidobacterium longum (a bacterium found in the gastrointestinal tract) tended to have improved overall survival after CAR-T cell therapy. I discovered that there is

In addition, the researchers found that Bacteroides egerthii was associated with higher response rates to CAR-T cell therapy, while Bacteroides stercoris was associated with lack of response.

However, Jain pointed out that there is still no adequate way in which a person can alter their microbiome through food or additional supplements. Instead, patients should focus on eating as healthy as possible.

“Diet is a very human thing. We believe that diet and what we eat has a huge impact on the results we are trying to get. And I think that’s true,” he says. said. “But in certain medical situations, particularly in the area of ​​CAR-T cell therapy for lymphoma, which I am treating, we still don’t know enough about the exact details of how to do that. What we recommend is to eat healthy, and we have nutritionists and other people who can help with that process.”

Looking ahead, Jain said he hopes to see better interventions to improve gut microbiome health. We also believe that it is a real possibility, based on research on this topic, not just in cancer treatment, but in healthcare in general.

“Given the fact that so many people are interested in this area, and a lot of energy and ideas are being put into new ways to improve it, we are coordinating these factors productively. And improving patient outcomes is what we’ve always been here for, patients cured by our treatments. We are doing everything we can to increase the number of

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