{"doi":"10.1093/cid/ciac888","title":"Reply to de Mooij et al","abstract":"To the Editor—We thank the authors for their interest in our report and for proposing an alternative model where Blautia may be solely a surrogate biomarker of intestinal mucosal integrity rather than directly involved in mitigating the pathogenesis of neutropenic fever. The argument is based on the proposal that a temporal association between a reduction in Blautia abundance, reduction in next-day citrulline, and increased incidence of neutropenic fever in the subsequent 24 hours—in this specific temporal sequence—may not reflect a causal link between the first 2 components because the reduction in citrulline may have preceded Blautia decline. We agree with the authors that the clinical scenario is complex, and we also agree that the authors’ model as an alternative explanation is valid and supported by the data. The simultaneity of the microbial changes and mucosal injury makes a cause-and-effect analysis using retrospective data inherently limited. In animal experiments, at least, effects in both directions have been observed. On one hand, chemotherapy/radiation and early alloreactivity can induce changes in microbiome composition [1]. Conversely, microbiome manipulations can attenuate or exacerbate the effects of chemotherapy, radiation, and alloreactivity [2–4]. While citrulline loss might have started before changes in Blautia, and cytotoxic mucosal injury was likely the main trigger, our model proposes that Blautia reduction contributed to maintenance or worsening of this loss. This hypothesis will need to be evaluated experimentally.","journal":"Clinical Infectious Diseases","year":2022,"id":313025,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9539,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":225648,"name":"Jonathan U. Peled","orcid":"0000-0002-4029-7625","position":1,"is_corresponding":false},{"id":653447,"name":"Christopher Staley","orcid":"0000-0002-2309-0083","position":2,"is_corresponding":false},{"id":313704,"name":"Armin Rashidi","orcid":"0000-0002-9384-272X","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-19T00:33:40.460845Z","pmid":"36370043","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}