title: Gastrointestinal microbial populations can distinguish pediatric and adolescent Acute Lymphoblastic Leukemia (ALL) at the time of disease diagnosis.
abstract: An estimated 15,000 children and adolescents under the age of 19 years are diagnosed with leukemia, lymphoma and other tumors in the USA every year. All children and adolescent acute leukemia patients will undergo chemotherapy as part of their treatment regimen. Fortunately, survival rates for most pediatric cancers have improved at a remarkable pace over the past three decades, and the overall survival rate is greater than 90 % today. However, significant differences in survival rate have been found in different age groups (94 % in 1-9.99 years, 82 % in ≥10 years and 76 % in ≥15 years). ALL accounts for about three out of four cases of childhood leukemia. Intensive chemotherapy treatment coupled with prophylactic or therapeutic antibiotic use could potentially have a long-term effect on the resident gastrointestinal (GI) microbiome. The composition of GI microbiome and its changes upon chemotherapy in pediatric and adolescent leukemia patients is poorly understood. In this study, using 16S rRNA marker gene sequences we profile the GI microbial communities of pediatric and adolescent acute leukemia patients before and after chemotherapy treatment and compare with the microbiota of their healthy siblings.
  
  
  
  Our study cohort consisted of 51 participants, made up of matched pediatric and adolescent patients with ALL and a healthy sibling. We elucidated and compared the GI microbiota profiles of patients and their healthy sibling controls via analysis of 16S rRNA gene sequencing data. We assessed the GI microbiota composition in pediatric and adolescent patients with ALL during the course of chemotherapy by comparing stool samples taken before chemotherapy with stool samples collected at varying time points during the chemotherapeutic treatment. The microbiota profiles of both patients and control sibling groups are dominated by members of Bacteroides, Prevotella, and Faecalibacterium. At the genus level, both groups share many taxa in common, but the microbiota diversity of the patient group is significantly lower than that of the control group. It was possible to distinguish between the patient and control groups based on their microbiota profiles. The top taxa include Anaerostipes, Coprococcus, Roseburia, and Ruminococcus2 with relatively higher abundance in the control group. The observed microbiota changes are likely the result of several factors including a direct influence of therapeutic compounds on the gut flora and an indirect effect of chemotherapy on the immune system, which, in turn, affects the microbiota.
  
  
  
  This study provides significant information on GI microbiota populations in immunocompromised children and opens up the potential for developing novel diagnostics based on stool tests and therapies to improve the dysbiotic condition of the microbiota at the time of diagnosis and in the earliest stages of chemotherapy.
authors.affiliation: J. Craig Venter Institute (JCVI), 9714 Medical Center Drive, Rockville, MD, 20850, USA. raja@jcvi.org.
authors.forename: Seesandra V
authors.initials: SV
authors.lastname: Rajagopala
authors.affiliation: JCVI, La Jolla, 92037, CA, USA.
authors.forename: Shibu
authors.initials: S
authors.lastname: Yooseph
authors.affiliation: J. Craig Venter Institute (JCVI), 9714 Medical Center Drive, Rockville, MD, 20850, USA.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Harkins
authors.affiliation: JCVI, La Jolla, 92037, CA, USA.
authors.forename: Kelvin J
authors.initials: KJ
authors.lastname: Moncera
authors.affiliation: Hyundai Cancer Genomics Center, Children's Hospital Orange County (CHOC Children's), Orange, CA, USA.|Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California-Irvine, Orange, CA, USA.
authors.forename: Keri B
authors.initials: KB
authors.lastname: Zabokrtsky
authors.affiliation: JCVI, La Jolla, 92037, CA, USA.
authors.forename: Manolito G
authors.initials: MG
authors.lastname: Torralba
authors.affiliation: J. Craig Venter Institute (JCVI), 9714 Medical Center Drive, Rockville, MD, 20850, USA.
authors.forename: Andrey
authors.initials: A
authors.lastname: Tovchigrechko
authors.affiliation: JCVI, La Jolla, 92037, CA, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Highlander
authors.affiliation: J. Craig Venter Institute (JCVI), 9714 Medical Center Drive, Rockville, MD, 20850, USA.
authors.forename: Rembert
authors.initials: R
authors.lastname: Pieper
authors.affiliation: Hyundai Cancer Genomics Center, Children's Hospital Orange County (CHOC Children's), Orange, CA, USA.|Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California-Irvine, Orange, CA, USA.|Division of Oncology, Hyundai Cancer Institute, CHOC Children's, Orange, CA, USA.|Department of Pediatrics, School of Medicine, University of California-Irvine, Orange, CA, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Sender
authors.affiliation: J. Craig Venter Institute (JCVI), 9714 Medical Center Drive, Rockville, MD, 20850, USA. kenelson@jcvi.org.|JCVI, La Jolla, 92037, CA, USA. kenelson@jcvi.org.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019540:Area Under Curve; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification; D044822:Biodiversity; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000737:chemistry / Q000302:isolation & purification / Q000378:metabolism; D005243:Feces / Q000382:microbiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D064307:Microbiota; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000737:chemistry / Q000302:isolation & purification / Q000378:metabolism; D012372:ROC Curve; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S
keywords: 16S rRNA gene sequencing; Gastrointestinal microbiota; Pediatric leukemia; Ribosomal RNA; rRNA