Prebiotics protect against acute graft-versus-host disease and preserve the gut microbiota in stem cell transplantation

Kota Yoshifuji, Kyoko Inamoto, Yuko Kiridoshi, Kozue Takeshita, Satoshi Sasajima, Yukiko Shiraishi, Yuko Yamashita, Yuko Nisaka, Yukari Ogura, Rie Takeuchi, Takashi Toya, Aiko Igarashi, Yuho Najima, Noriko Doki, Takeshi Kobayashi, Kazuteru Ohashi, Wataru Suda, Koji Atarashi, Atsushi Shiota, Masahira HattoriKenya Honda, Kazuhiko Kakihana

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


Acute graft-versus-host disease (aGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Therefore, management of aGVHD is important for successful transplantation. Mucosal damage and alteration of the gut microbiota after allo-HSCT are key factors in the development of aGVHD. We conducted a prospective study to evaluate the ability of prebiotics, which can alleviate mucosal damage and manipulate the gut microbiota, to mitigate posttransplantation complications, including aGVHD. Resistant starch (RS) and a commercially available prebiotics mixture, GFO, were administered to allo-HSCT recipients from pretransplantation conditioning to day 28 after allo-HSCT. Prebiotic intake mitigated mucosal injury and reduced the incidence of all aGVHD grades combined and of aGVHD grades 2 to 4. The cumulative incidence of skin aGVHD was markedly decreased by prebiotics intake. Furthermore, the gut microbial diversity was well maintained and butyrate-producing bacterial population were preserved by prebiotics intake. In addition, the posttransplantation fecal butyrate concentration was maintained or increased more frequently in the prebiotics group. These observations indicate that prebiotic intake may be an effective strategy for preventing aGVHD in allo-HSCT, thereby improving treatment outcomes and the clinical utility of stem cell transplantation approaches. This study was registered on the University Hospital Medical Information Network (UMIN) clinical trials registry ( as #UMIN000027563.

Original languageEnglish
Pages (from-to)4607-4617
Number of pages11
JournalBlood Advances
Issue number19
Publication statusPublished - 2020 Oct 13

ASJC Scopus subject areas

  • Hematology


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