Diverse T-cell responses characterize the different manifestations of cutaneous graft-versus-host disease

MC Brüggen, I Klein, H Greinix, W Bauer… - Blood, The Journal …, 2014 - ashpublications.org
MC Brüggen, I Klein, H Greinix, W Bauer, Z Kuzmina, W Rabitsch, P Kalhs, P Petzelbauer…
Blood, The Journal of the American Society of Hematology, 2014ashpublications.org
Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem
cell transplantation (HCT) and can present in an acute (aGVHD), a chronic lichenoid
(clGVHD), and a chronic sclerotic form (csGVHD). It is unclear whether similar or different
pathomechanisms lead to these distinct clinical presentations. To address this issue, we
collected lesional skin biopsies from aGVHD (n= 25), clGVHD (n= 17), and csGVHD (n= 7)
patients as well as serial nonlesional biopsies from HCT recipients (prior to or post-HCT)(n …
Abstract
Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (HCT) and can present in an acute (aGVHD), a chronic lichenoid (clGVHD), and a chronic sclerotic form (csGVHD). It is unclear whether similar or different pathomechanisms lead to these distinct clinical presentations. To address this issue, we collected lesional skin biopsies from aGVHD (n = 25), clGVHD (n = 17), and csGVHD (n = 7) patients as well as serial nonlesional biopsies from HCT recipients (prior to or post-HCT) (n = 14) and subjected them to phenotypic and functional analyses. Our results revealed striking differences between aGVHD and clGVHD. In aGVHD, we found a clear predominance of T helper (Th)2 cytokines/chemokines and, surprisingly, of interleukin (IL)-22 messenger RNA as well as an increase of IL-22–producing CD4+ T cells. Thymic stromal lymphopoietin, a cytokine skewing the immune response toward a Th2 direction, was elevated at day 20 to 30 post-HCT in the skin of patients who later developed aGVHD. In sharp contrast to aGVHD, the immune response occurring in clGVHD showed a mixed Th1/Th17 signature with upregulated Th1/Th17 cytokine/chemokine transcripts and elevated numbers of interferon-γ– and IL-17–producing CD8+ T cells. Our findings shed new light on the T-cell responses involved in the different manifestations of cutaneous GVHD and identify molecular signatures indicating the development of the disease.
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