Upper and Lower Respiratory Tract Compartmentalization in Pediatric Stem Cell Transplantation - PubMed
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- #pediatric lung injury
- #respiratory compartmentalization
- #stem cell transplantation
- Lung injury after hematopoietic stem cell transplantation arises from infection, chemotherapy toxicity, and alloreactive inflammation.
- Analysis of paired nasal and BAL samples from pediatric HCT patients shows minimal correlation in gene expression (median correlation near zero) and cellular composition.
- BAL microbiomes feature fewer commensal bacteria, more fungi and DNA viruses, and are linked to diminished immune signaling and epithelial injury responses.
- Nasal bacterial RNA aligns with inflammatory gene expression, but nasal samples offer minimal prognostic value.
- BAL signatures of microbiome depletion, epithelial injury, and immune dysregulation are associated with poor outcomes like death or prolonged mechanical ventilation.
- The findings underscore alveolar compartmentalization in pediatric HCT and highlight the need for minimally-invasive yet informative diagnostics.