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Microbiome-gut-brain axis in cancer treatment-related psychoneurological toxicities and symptoms: a systematic review

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Abstract

Purpose

The microbiome-gut-brain (MGB) axis provides a dynamic model to understand associations between the gut microbiota and psychoneurological comorbidities. The role of the MGB axis in cancer treatment-related psychoneurological symptoms (PNS) remains unknown. The purpose of this study was to conduct a systematic review of the existing literature to identify the influence of the gut microbiota on cancer and cancer treatment-related PNS and toxicities mediated by the MGB axis.

Methods

We searched the databases of PubMed, Embase, and Web of Science from their earliest records to October 2019. All studies identified in the database searches were screened by title and abstract, followed by a review of the full texts. The Johns Hopkins Nursing Evidence-Based Practice Model was adopted to assess the evidence levels and qualities; the Joanna Briggs Institute critical appraisal tools were used to assess the methodological quality and the possibility of bias for each included study. All the study findings were combined, synthesized, and presented through narrative format.

Results

Six studies were included in this systematic review. These studies primarily focused on cancer survivorship while receiving chemotherapy, and they were conducted between 2016 and 2019. The gut microbiome was assessed via fecal samples, which were analyzed using 16S rRNA sequencing approaches. With small-scale studies, the gut microbiota was associated with cancer treatment-related PNS, including fatigue, anxiety, depression, sleep disturbance, cognitive impairment, and chemotherapy-induced peripheral neuropathy. A higher relative abundance of Bacteroides was associated with a higher level of fear of cancer recurrence but a higher relative abundance of Lachnospiraceae.g and Ruminococcus was associated with a lower level in fear of cancer recurrence. Changes in fatigue interference were associated with the frequency of genera Faecalibacterium and Prevotella, and changes in anxiety were associated with the frequency of genera Coprococcus and Bacteroides.

Conclusions

The gut microbiota showed significant associations with cancer treatment-related PNS. Recent work regarding the MGB axis in cancer psychoneurological toxicities focused primarily on individual toxicity and symptoms in cancer survivors with chemotherapy exposure. Associations between the gut microbiota and PNS should be further studied in cancer populations across different ages, cancer types, and treatment modalities.

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Abbreviations

5-HT:

5-Hydroxytryptamine

CNS:

Central nervous system

EEC:

Enteroendocrine cell

FMT:

Fecal microbiota transplantation

GI:

Gastrointestinal

GLP-1:

Glucagon-like peptide 1

JBI:

Joanna Briggs Institute

MGB:

Microbiome-gut-brain axis

NPY:

Neuropeptide Y

PNS:

Psychoneurological symptoms

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PYY:

Peptide YY

TLR:

Toll-like receptor

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Funding

Jinbing Bai was supported by grants from the National Institute of Health/National Institute of Nursing Research (1K99NR017897-01), NCI R25CA203650 (PI: Melinda Irwin), and the Oncology Nursing Foundation Grant from the Oncology Nursing Society.

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Authors and Affiliations

  1. Department of Biology, School of Medicine, Emory University, Atlanta, GA, 30322, USA

    Byron Chang Song

  2. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA

    Jinbing Bai

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  1. Byron Chang Song
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Byron Song conducted and revised the manuscript, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Jinbing Bai contributed to study conceptualization and design; acquisition, analysis, and interpretation; drafted the manuscript; critically revised the manuscript; gave final approval; and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to Jinbing Bai.

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Song, B.C., Bai, J. Microbiome-gut-brain axis in cancer treatment-related psychoneurological toxicities and symptoms: a systematic review. Support Care Cancer 29, 605–617 (2021). https://doi.org/10.1007/s00520-020-05739-9

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