Obesity induces gut microbiota alterations and augments acute graft-versus-host disease after allogeneic stem cell transplantation

Lam T. Khuat, Catherine T. Le, Chien Chun Steven Pai, Robin R Shields-Cutler, Shernan G. Holtan, Armin Rashidi, Sarah L Atkins, Dan Knights, Jesus I. Luna, Cordelia Dunai, Ziming Wang, Ian R. Sturgill, Kevin M. Stoffel, Alexander A. Merleev, Shyam K. More, Emanual Maverakis, Helen E. Raybould, Mingyi Chen, Robert J. Canter, Arta M. MonjazebManeesh Dave, James L.M. Ferrara, John E. Levine, Dan L. Longo, Mehrdad Abedi, Bruce R. Blazar, William J. Murphy

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30 Scopus citations


The efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited by acute and chronic graft-versus-host disease (GVHD). The impact of obesity on allo-HSCT outcomes is poorly understood. Here, we report that obesity had a negative and selective impact on acute gut GVHD after allo-HSCT in mice with diet-induced obesity (DIO). These animals exhibited increased gut permeability, endotoxin translocation across the gut, and radiation-induced gastrointestinal damage after allo-HSCT. After allo-HSCT, both male and female DIO mouse recipients showed increased proinflammatory cytokine production and expression of the GVHD marker ST2 (IL-33R) and MHC class II molecules; they also exhibited decreased survival associated with acute severe gut GVHD. This rapid-onset, obesity-associated gut GVHD depended on donor CD4+ T cells and occurred even with a minor MHC mismatch between donor and recipient animals. Retrospective analysis of clinical cohorts receiving allo-HSCT transplants from unrelated donors revealed that recipients with a high body mass index (BMI, >30) had reduced survival and higher serum ST2 concentrations compared with nonobese transplant recipients. Assessment of both DIO mice and allo-HSCT recipients with a high BMI revealed reduced gut microbiota diversity and decreased Clostridiaceae abundance. Prophylactic antibiotic treatment protected DIO mouse recipients from endotoxin translocation across the gut and increased inflammatory cytokine production, as well as gut pathology and mortality, but did not protect against later development of chronic skin GVHD. These results suggest that obesity-induced alterations of the gut microbiota may affect GVHD after allo-HSCT in DIO mice, which could be ameliorated by prophylactic antibiotic treatment.

Original languageEnglish (US)
Article numbereaay7713
JournalScience Translational Medicine
Issue number571
StatePublished - Nov 25 2020

Bibliographical note

Funding Information:
This work was funded by NIH grants R01 CA214048, R01 HL056067, R37 AI034495, and P01 CA039542; the UC Davis Comprehensive Cancer Center Support Grant (CCSG) (P30 CA093373); and the UC Davis Mouse Metabolic Phenotyping Center (MMPC) grant (DK092993). The content of this publication does not necessarily reflect the view or policies of the Department of Health and Human Services, or mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

Publisher Copyright:
Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural


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