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An aberrant NOTCH2-BCR signaling axis in B cells from patients with chronic GVHD. Blood 2017; 130:2131-2145. [PMID: 28851699 DOI: 10.1182/blood-2017-05-782466] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022] Open
Abstract
B-cell receptor (BCR)-activated B cells contribute to pathogenesis in chronic graft-versus-host disease (cGVHD), a condition manifested by both B-cell autoreactivity and immune deficiency. We hypothesized that constitutive BCR activation precluded functional B-cell maturation in cGVHD. To address this, we examined BCR-NOTCH2 synergy because NOTCH has been shown to increase BCR responsiveness in normal mouse B cells. We conducted ex vivo activation and signaling assays of 30 primary samples from hematopoietic stem cell transplantation patients with and without cGVHD. Consistent with a molecular link between pathways, we found that BCR-NOTCH activation significantly increased the proximal BCR adapter protein BLNK. BCR-NOTCH activation also enabled persistent NOTCH2 surface expression, suggesting a positive feedback loop. Specific NOTCH2 blockade eliminated NOTCH-BCR activation and significantly altered NOTCH downstream targets and B-cell maturation/effector molecules. Examination of the molecular underpinnings of this "NOTCH2-BCR axis" in cGVHD revealed imbalanced expression of the transcription factors IRF4 and IRF8, each critical to B-cell differentiation and fate. All-trans retinoic acid (ATRA) increased IRF4 expression, restored the IRF4-to-IRF8 ratio, abrogated BCR-NOTCH hyperactivation, and reduced NOTCH2 expression in cGVHD B cells without compromising viability. ATRA-treated cGVHD B cells had elevated TLR9 and PAX5, but not BLIMP1 (a gene-expression pattern associated with mature follicular B cells) and also attained increased cytosine guanine dinucleotide responsiveness. Together, we reveal a mechanistic link between NOTCH2 activation and robust BCR responses to otherwise suboptimal amounts of surrogate antigen. Our findings suggest that peripheral B cells in cGVHD patients can be pharmacologically directed from hyperactivation toward maturity.
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Han L, Shen L, Zhu Y, Qiu Y. A monoclonal antibody against CD86 and its protection in a murine lupus nephritis model of chronic graft-versus-host disease. Immunopharmacol Immunotoxicol 2017; 39:285-291. [PMID: 28747139 DOI: 10.1080/08923973.2017.1354878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Lupus nephritis is the most common complication that causes the death of systemic lupus erythematosus patients. CD28/CTLA4 and their ligands CD80 or CD86 costimulatory pathway play a pivotal role in autoimmune disease and organ transplantation. OBJECTIVES We generated a monoclonal antibody (clone 1D1) against human CD86 (1D1) that could recognize both human and mouse CD86, and blocked the CD86/CD28 costimulatory pathway with our mAb on a murine lupus nephritis model induced with chronic graft-versus-host disease (cGVHD). MATERIALS AND METHODS Experimental lupus nephritis mice were induced with cGVHD, and splenocyte population were analyzed by flow cytometry. Autoantibodies and proteinuria were detected to evaluate the severity of lupus nephritis. The change of histopathology was observed by microscopy, fluorescence microscopy and electron microscopy. RESULTS we successfully generated a monoclonal antibody against human CD86(1D1). 1D1 mAb could recognize not only human CD86, but also mouse CD86. 1D1 was applied to the cGVHD-induced experimental lupus nephritis model, and our study found the production of ANA and anti-dsDNA in the 1D1-treated group was lower than those in IgG-treated group after four weeks. The pathological injure of kidney in the 1D1-treated group was lighten than that in IgG-treated group. DISCUSSION AND CONCLUSIONS Our data showed that blockade of CD86/CD28 with 1D1 induced a significant remission of proteinuria, production of autoantibodies, immune complex deposition and renal parenchyma lesions in experimental mice. Anti-CD86 Abs might be a potential method for immune therapy in autoimmune diseases and transplantation.
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Affiliation(s)
- Lianhua Han
- a Department of cardiology , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China
| | - Lijun Shen
- b Institutes of Biology and Medical Sciences , Soochow University , Suzhou , Jiangsu , China
| | - Ying Zhu
- c Department of clinical laboratory , The First Affiliated Hospital of Soochow University , Suzhou , Jiangsu , China
| | - Yuhua Qiu
- d Department of Immunology , Medical College, Soochow University , Suzhou , Jiangsu , China
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Abdel-Azim H, Elshoury A, Mahadeo KM, Parkman R, Kapoor N. Humoral Immune Reconstitution Kinetics after Allogeneic Hematopoietic Stem Cell Transplantation in Children: A Maturation Block of IgM Memory B Cells May Lead to Impaired Antibody Immune Reconstitution. Biol Blood Marrow Transplant 2017; 23:1437-1446. [PMID: 28495643 DOI: 10.1016/j.bbmt.2017.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
Although T cell immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been well studied, long-term B cell immune reconstitution remains less characterized. We evaluated humoral immune reconstitution among 71 pediatric allo-HSCT recipients. Although tetanus toxoid antibody levels were normal at 1 year after allo-HSCT, antipolysaccharide carbohydrate antibodies remained persistently low for up to 5 years. While naive B cell counts normalized by 6 months, IgM memory B cell deficiency persisted for up to 2 years (P = .01); switched memory B cell deficiency normalized by 1 year after allo-HSCT. CD4+ T cell immune reconstitution correlated with that of switched memory B cells as early as 6 months after allo-HSCT (r = .55, P = .002) but did not correlate with IgM memory B cells at any time point after allo-HSCT. Taken together, this suggests that allo-HSCT recipients have impaired antibody immune reconstitution, mainly due to IgM memory B cell maturation block, compared with more prompt T cell-dependent switched memory cell immune reconstitution. We further explored other factors that might affect humoral immune reconstitution. The use of total body irradiation was associated with lower naive B cells counts at 6 months after HSCT (P = .04) and lower IgM (P = .008) and switched (P = .003) memory B cells up to 2 years. Allo-HSCT recipients with extensive chronic graft-versus-host disease had lower IgM memory B cell counts (P = .03) up to 2 years after allo-HSCT. The use of cord blood was associated with better naive (P = .01), IgM (P = .0005), and switched memory (P = .006) B cells immune reconstitution. These findings may inform future prophylaxis and treatment strategies regarding risk of overwhelming infection, graft-versus-host disease, and post-allogeneic HSCT revaccination.
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Affiliation(s)
- Hisham Abdel-Azim
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California.
| | - Amro Elshoury
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Kris M Mahadeo
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California
| | - Robertson Parkman
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California
| | - Neena Kapoor
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California
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Skert C, Perucca S, Chiarini M, Giustini V, Sottini A, Ghidini C, Martellos S, Cattina F, Rambaldi B, Cancelli V, Malagola M, Turra A, Polverelli N, Bernardi S, Imberti L, Russo D. Sequential monitoring of lymphocyte subsets and of T-and-B cell neogenesis indexes to identify time-varying immunologic profiles in relation to graft-versus-host disease and relapse after allogeneic stem cell transplantation. PLoS One 2017; 12:e0175337. [PMID: 28399164 PMCID: PMC5388479 DOI: 10.1371/journal.pone.0175337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/24/2017] [Indexed: 11/19/2022] Open
Abstract
T and B lymphocyte subsets have been not univocally associated to Graft-versus-host disease (GVHD) and relapse of hematological malignancies after stem cell transplantation (SCT). Their sequential assessment together with B and T cell neogenesis indexes has been not thoroughly analysed in relation to these changing and interrelated immunologic/clinic events yet. Lymphocyte subsets in peripheral blood (PB) and B and T cell neogenesis indexes were analysed together at different time points in a prospective study of 50 patients. Principal component analysis (PCA) was used as first step of multivariate analysis to address issues related to a high number of variables versus a relatively low number of patients. Multivariate analysis was completed by Fine-Gray proportional hazard regression model. PCA identified 3 clusters of variables (PC1-3), which correlated with acute GVHD: PC1 (pre-SCT: KRECs≥6608/ml, unswitched memory B <2.4%, CD4+TCM cells <45%; HR 0.5, p = 0.001); PC2 (at aGVHD onset: CD4+>44%, CD8+TCM cells>4%; HR 1.9, p = 0.01), and PC3 (at aGVHD onset: CD4+TEMRA<1, total Treg<4, TregEM <2 cells/μl; HR 0.5, p = 0.002). Chronic GVHD was associated with one PC (TregEM <2 cells/μl at day+28, CD8+TEMRA<43% at day+90, immature B cells<6 cells/μl and KRECs<11710/ml at day+180; HR 0.4, P = 0.001). Two PC correlated with relapse: PC1 (pre-SCT: CD4+ <269, CD4+TCM <120, total Treg <18, TregCM <8 cells/μl; HR 4.0, p = 0.02); PC2 (pre-SCT mature CD19+ >69%, switched memory CD19+ = 0 cells and KRECs<6614/ml at +90; HR 0.1, p = 0.008). All these immunologic parameters were independent indicators of chronic GVHD and relapse, also considering the possible effect of previous steroid-therapy for acute GVHD. Specific time-varying immunologic profiles were associated to GVHD and relapse. Pre-SCT host immune-microenvironment and changes of B cell homeostasis could influence GVH- and Graft-versus-Tumor reactions. The paradoxical increase of EM Treg in PB of patients with GVHD could be explained by their compartmentalization outside lymphoid tissues, which are of critical relevance for regulation of GVH reactions.
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Affiliation(s)
- Cristina Skert
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
- * E-mail:
| | - Simone Perucca
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Marco Chiarini
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Viviana Giustini
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Sottini
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Claudia Ghidini
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Martellos
- Department of Life Sciences, Research Unit of Biodiversity Informatics, University of Trieste, Trieste, Italy
| | - Federica Cattina
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Benedetta Rambaldi
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Valeria Cancelli
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Michele Malagola
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Alessandro Turra
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Nicola Polverelli
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
| | - Simona Bernardi
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Luisa Imberti
- Centro Ricerca Emato-oncologica AIL (CREA), Spedali Civili of Brescia, Brescia, Italy
| | - Domenico Russo
- Chair of Haematology, Stem Cell Transplantation Unit, University of Brescia, Brescia, Italy
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Zadik Y, Elad S, Shapira A, Shapira MY. Treatment of oral mucosal manifestations of chronic graft-versus-host disease: dexamethasone vs. budesonide. Expert Opin Pharmacother 2017; 18:235-242. [PMID: 28081677 DOI: 10.1080/14656566.2017.1282464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The oral mucosa is commonly involved in chronic graft-versus-host disease (cGVHD). Oral mucosal cGVHD markedly affect individual's daily function and wellbeing. In some cases, it might become a life threating complication. Areas covered: This article describes the rationale for treatment, method of topical application in the oral cavity, evidence supporting the topical administration of dexamethasone and budesonide for oral cGVHD, and their adverse effects. Expert opinion: Evidence supports the use of topical dexamethasone and budesonide for treatment of oral cGVHD. Topical corticosteroid choice for oral cGVHD, takes into consideration the potency, bioavailability, preferred concentration, and possible adverse effects. Budesonide's pharmacological characteristics mark it as a preferable topical agent for oral cGVHD.
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Affiliation(s)
- Yehuda Zadik
- a Department of Oral Medicine, Sedation and Maxillofacial Imaging , Hadassah-Hebrew University School of Dental Medicine , Jerusalem , Israel.,b Department of Oral Medicine , The Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces , Tel Hashomer , Israel
| | - Sharon Elad
- c Division of Oral Medicine, Hospital General Dentistry, Eastman Institute for Oral Health , University of Rochester Medical Center , Rochester , NY , USA.,d Wilmot Cancer Center , University of Rochester Medical Center , Rochester , NY , USA
| | - Anat Shapira
- e Pharmacy Division , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Michael Y Shapira
- f Bone Marrow Transplantation and Cancer Immunotherapy Department , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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56
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Im A, Hakim FT, Pavletic SZ. Novel targets in the treatment of chronic graft-versus-host disease. Leukemia 2016; 31:543-554. [PMID: 27899803 DOI: 10.1038/leu.2016.367] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 12/19/2022]
Abstract
Despite advances that have improved survival after allogeneic hematopoietic stem cell transplantation (HCT), chronic graft-versus-host disease (GVHD) remains a leading cause of late morbidity and mortality after transplant. Current treatment options show limited efficacy in steroid-refractory disease, and there exists a paucity of robust data to guide management decisions. Lack of United States Food and Drug Administration (FDA)- or European Medicines Agency (EMA)-approved agents in GVHD underscore the importance of developing novel therapies. Better understanding of the biology of chronic GVHD has provided novel targets for treatment, and structured guidelines in diagnosis and in clinical trial design have provided a common language and pathways for research in this area. These, combined with the surge of drug development in Oncology and Immunology, are factors that have contributed to the accelerating field of drug development and clinical research in chronic GVHD. In these exciting times, it is possible to foresee long awaited advances in the treatment of this devastating complication of HCT. This review will summarize the ongoing clinical development for novel therapies in chronic GVHD.
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Affiliation(s)
- A Im
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Cancer Institute and UPMC Cancer Centers, Pittsburgh, PA, USA.,Experimental Transplantation and Immunology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - F T Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - S Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
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57
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Mechanistic approaches for the prevention and treatment of chronic GVHD. Blood 2016; 129:22-29. [PMID: 27821505 DOI: 10.1182/blood-2016-08-686659] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/11/2016] [Indexed: 02/07/2023] Open
Abstract
Clinical outcomes for patients undergoing allogeneic hematopoietic stem cell transplantation continue to improve, but chronic graft-versus-host disease (GVHD) remains a common toxicity and major cause of nonrelapse morbidity and mortality. Treatment of chronic GVHD has previously relied primarily on corticosteroids and other broadly immune suppressive agents. However, conventional immune suppressive agents have limited clinical efficacy in chronic GVHD, and prolonged immune suppressive treatments result in additional toxicities that further limit clinical recovery from transplant and return to normal daily function. Recent advances in our understanding of the immune pathology of chronic GVHD offer the possibility that new therapeutic approaches can be directed in more precise ways to target specific immunologic mechanisms and pathways. In this review, we briefly summarize current standard treatment options and present new therapeutic approaches that are supported by preclinical studies and early-phase clinical trials suggesting that these approaches may have clinical utility for treatment or prevention of chronic GVHD. Further evaluation of these new therapeutic options in well-designed prospective multicenter trials are needed to identify the most effective new agents and improve outcomes for patients with chronic GVHD.
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58
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SnapshotDx Quiz: November 2016. J Invest Dermatol 2016; 136:e115. [PMID: 30477672 DOI: 10.1016/j.jid.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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59
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Uygun V, Daloğlu H, Öztürkmen SI, Döşemeci L, Karasu G, Hazar V, Yeşilipek A. Extracorporeal photopheresis did not prevent the development of an autoimmune disease: myasthenia gravis. Transfusion 2016; 56:3081-3085. [DOI: 10.1111/trf.13821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Vedat Uygun
- Pediatric Bone Marrow Transplantation Unit; Medical Park Antalya Hospital, Bahçeşehir University
| | - Hayriye Daloğlu
- Pediatric Bone Marrow Transplantation Unit; Medical Park Antalya Hospital; Antalya Turkey
| | - Seda Irmak Öztürkmen
- Pediatric Bone Marrow Transplantation Unit; Medical Park Antalya Hospital; Antalya Turkey
| | - Levent Döşemeci
- Intensive Care Unit; Istanbul Kemerburgaz University Faculty of Medicine
| | - Gülsün Karasu
- Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital; Bahçeşehir University
| | - Volkan Hazar
- Pediatric Hematology and Oncology and Bone Marrow Transplantation Unit; Medipol University Faculty of Medicine; Istanbul Turkey
| | - Akif Yeşilipek
- Pediatric Bone Marrow Transplantation Unit; Medical Park Antalya Hospital, Bahçeşehir University
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60
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Hu R, Liu Y, Su M, Song Y, Rood D, Lai L. Transplantation of Donor-Origin Mouse Embryonic Stem Cell-Derived Thymic Epithelial Progenitors Prevents the Development of Chronic Graft-versus-Host Disease in Mice. Stem Cells Transl Med 2016; 6:121-130. [PMID: 28170174 PMCID: PMC5442732 DOI: 10.5966/sctm.2016-0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/16/2016] [Indexed: 01/03/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for many malignant and nonmalignant diseases. However, chronic graft-versus-host disease (cGVHD) remains a significant cause of late morbidity and mortality after allogeneic HSCT. cGVHD often manifests as autoimmune syndrome. Thymic epithelial cells (TECs) play a critical role in supporting negative selection and regulatory T-cell (Treg) generation. Studies have shown that damage in TECs is sufficient to induce cGVHD. We have previously reported that mouse embryonic stem cells (mESCs) can be selectively induced to generate thymic epithelial progenitors (TEPs) in vitro. When transplanted in vivo, mESC-TEPs further develop into TECs that support T-cell development. We show here that transplantation of donor-origin mESC-TEPs into cGVHD recipients induces immune tolerance to both donor and host antigens and prevents the development of cGVHD. This is associated with more TECs and Tregs. Our results suggest that embryonic stem cell-derived TEPs may offer a new tool to control cGVHD. Stem Cells Translational Medicine 2017;6:121-130.
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Affiliation(s)
- Rong Hu
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- Guizhou Medical University, Guizhou, People's Republic of China
| | - Yalan Liu
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Min Su
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- Guizhou Medical University, Guizhou, People's Republic of China
| | - Yinhong Song
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Debra Rood
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Laijun Lai
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
- University of Connecticut Stem Cell Institute, University of Connecticut, Storrs, Connecticut, USA
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IL-10+ regulatory B cells are enriched in cord blood and may protect against cGVHD after cord blood transplantation. Blood 2016; 128:1346-61. [PMID: 27439912 DOI: 10.1182/blood-2016-01-695122] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022] Open
Abstract
Cord blood (CB) offers a number of advantages over other sources of hematopoietic stem cells, including a lower rate of chronic graft-versus-host disease (cGVHD) in the presence of increased HLA disparity. Recent research in experimental models of autoimmunity and in patients with autoimmune or alloimmune disorders has identified a functional group of interleukin-10 (IL-10)-producing regulatory B cells (Bregs) that negatively regulate T-cell immune responses. At present, however, there is no consensus on the phenotypic signature of Bregs, and their prevalence and functional characteristics in CB remain unclear. Here, we demonstrate that CB contains an abundance of B cells with immunoregulatory function. Bregs were identified in both the naive and transitional B-cell compartments and suppressed T-cell proliferation and effector function through IL-10 production as well as cell-to-cell contact involving CTLA-4. We further show that the suppressive capacity of CB-derived Bregs can be potentiated through CD40L signaling, suggesting that inflammatory environments may induce their function. Finally, there was robust recovery of IL-10-producing Bregs in patients after CB transplantation, to higher frequencies and absolute numbers than seen in the peripheral blood of healthy donors or in patients before transplant. The reconstituting Bregs showed strong in vitro suppressive activity against allogeneic CD4(+) T cells, but were deficient in patients with cGVHD. Together, these findings identify a rich source of Bregs and suggest a protective role for CB-derived Bregs against cGVHD development in CB recipients. This advance could propel the development of Breg-based strategies to prevent or ameliorate this posttransplant complication.
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Kennedy VE, Savani BN, Greer JP, Kassim AA, Engelhardt BG, Goodman SA, Sengsayadeth S, Chinratanalab W, Jagasia M. Reduced-Intensity Conditioning with Fludarabine, Cyclophosphamide, and Rituximab Is Associated with Improved Outcomes Compared with Fludarabine and Busulfan after Allogeneic Stem Cell Transplantation for B Cell Malignancies. Biol Blood Marrow Transplant 2016; 22:1801-1807. [PMID: 27377900 DOI: 10.1016/j.bbmt.2016.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
Reduced-intensity conditioning (RIC) has been used increasingly for allogeneic hematopoietic cell transplantation to minimize transplant-related mortality while maintaining the graft-versus-tumor effect. In B cell lymphoid malignancies, reduced-intensity regimens containing rituximab, an antiCD20 antibody, have been associated with favorable survival; however, the long-term outcomes of rituximab-containing versus nonrituximab-containing regimens for allogeneic hematopoietic cell transplantation in B cell lymphoid malignancies remain to be determined. We retrospectively analyzed 94 patients who received an allogeneic transplant for a B cell lymphoid malignancy. Of these, 33 received RIC with fludarabine, cyclophosphamide, and rituximab (FCR) and graft-versus-host disease (GVHD) prophylaxis with a calcineurin inhibitor and mini-methotrexate, and 61 received RIC with fludarabine and busulfan (FluBu) and GVHD prophylaxis with a calcineurin inhibitor and mycophenolate mofetil. The 2-year overall survival was superior in patients who received FCR versus FluBu (72.7% versus 54.1%, P = .031), and in multivariable analysis adjusted for Disease Risk Index and donor type, only the conditioning regimen (FluBu versus FCR: HR, 2.06; 95% CI, 1.04 to 4.08; P = .037) and Disease Risk Index (low versus intermediate/high: HR, .38; 95% CI, .17 to .86; P = .02) were independent predictors of overall survival. The 2-year cumulative incidence of chronic GVHD was lower in patients who received FCR versus FluBu (24.2% versus 51.7%, P = .01). There was no difference in rate of relapse/progression or acute GVHD. Our results demonstrate that the use of RIC with FCR and GVHD prophylaxis with a calcineurin inhibitor and mini-methotrexate is associated with decreased chronic GVHD and improved overall survival.
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Affiliation(s)
- Vanessa E Kennedy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John P Greer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Adetola A Kassim
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Brian G Engelhardt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Stacey A Goodman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Salyka Sengsayadeth
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Wichai Chinratanalab
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplant, Department of Medicine, Veterans Affairs Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Madan Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University, Nashville, Tennessee
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63
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Knorr DA, Wang H, Aurora M, MacMillan ML, Holtan SG, Bergerson R, Cao Q, Weisdorf DJ, Cooley S, Brunstein C, Miller JS, Wagner JE, Blazar BR, Verneris MR. Loss of T Follicular Helper Cells in the Peripheral Blood of Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2016; 22:825-33. [PMID: 26806586 PMCID: PMC5015683 DOI: 10.1016/j.bbmt.2016.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/05/2016] [Indexed: 11/29/2022]
Abstract
B cell antihost antibody production plays a central role in chronic graft-versus-host disease (cGVHD). T follicular helper (TFH) cells drive B cell responses and are implicated in this process. Given differences in cGVHD incidence between umbilical cord blood (UCB) and adult donor transplant recipients, we evaluated TFH cell reconstitution kinetics to define graft source differences and their potential pathogenic role in cGVHD. Although we observed significantly fewer TFH cells in the blood of UCB recipients (versus matched related donors [MRD]) early after transplantation, by 1 year the numbers of TFH cells were similar. Additionally, at both early (day 60) and late (1 year) time points, TFH cell phenotype was predominantly central memory cells in both cohorts. TFH cells were functional and able to produce multiple cytokines (INF-γ, TNF-α, IL-2, IL-17, and IL-21) after stimulation. In contrast to mouse models, where an enhanced frequency of splenic TFH cells contributes to cGVHD, patients with cGVHD showed significantly depleted circulating TFH cells after both UCB and MRD transplantation. Low numbers of TFH cells early after UCB transplantation could directly contribute to less cGVHD in this cohort. Additionally, systemic therapy (including steroids and calcineurin inhibitors) may contribute to decreases in TFH cells in patients with cGVHD. These data provide further evidence supporting the importance of TFH cells in cGVHD pathogenesis.
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Affiliation(s)
- David A Knorr
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Hongbo Wang
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Mukta Aurora
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Margaret L MacMillan
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Shernan G Holtan
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Rachel Bergerson
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Qing Cao
- Division of Blood and Marrow Transplantation, Department of Biostatistics, University of Minnesota, Minnesota
| | - Daniel J Weisdorf
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Sarah Cooley
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Claudio Brunstein
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Jeffery S Miller
- Division of Blood and Marrow Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - John E Wagner
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota
| | - Michael R Verneris
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minnesota.
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64
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Magenau J, Runaas L, Reddy P. Advances in understanding the pathogenesis of graft-versus-host disease. Br J Haematol 2016; 173:190-205. [PMID: 27019012 DOI: 10.1111/bjh.13959] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/15/2015] [Indexed: 01/24/2023]
Abstract
Allogeneic haematopoietic stem cell transplantation (HCT) is a potent immunotherapy with curative potential for several haematological disorders. Overcoming the immunological barrier of acute graft-versus-host disease (GVHD) remains a fundamental impediment to expanding the efficacy of HCT. GVHD reflects a complex pathological interaction between the innate and adaptive immune systems of the host and donor. Over the past decade there has been a tremendous advancement in our understanding of the cellular and molecular underpinnings of this devastating disease. In this review, we cover several recently appreciated facets of GVHD pathogenesis including novel extracellular mediators of inflammation, immune subsets, intracellular signal transduction, post-translation modifications and epigenetic regulation. We begin to develop general themes regarding the immunological pathways in GVHD pathogenesis, discuss critical outstanding questions, and explore new avenues for GVHD treatment and prevention.
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Affiliation(s)
- John Magenau
- Blood and Marrow Transplant Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lyndsey Runaas
- Blood and Marrow Transplant Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Pavan Reddy
- Blood and Marrow Transplant Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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65
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Chasset F, de Masson A, Le Buanec H, Xhaard A, de Fontbrune FS, Robin M, Rybojad M, Parquet N, Brignier AC, Coman T, Bengoufa D, Bergeron A, Peffault de Latour R, Bagot M, Bensussan A, Socié G, Bouaziz JD. APRIL levels are associated with disease activity in human chronic graft-versus-host disease. Haematologica 2016; 101:e312-5. [PMID: 26992945 DOI: 10.3324/haematol.2016.145409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- François Chasset
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité Dermatology Department, Saint-Louis Hospital, Paris
| | - Adèle de Masson
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité Dermatology Department, Saint-Louis Hospital, Paris
| | - Hélène Le Buanec
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité
| | - Aliénor Xhaard
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris
| | - Flore Sicre de Fontbrune
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris
| | - Marie Robin
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris
| | - Michel Rybojad
- University Paris Diderot, Sorbonne Paris Cité Dermatology Department, Saint-Louis Hospital, Paris
| | - Nathalie Parquet
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris Therapeutic Apheresis Unit, Saint-Louis Hospital, Paris
| | - Anne C Brignier
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris Therapeutic Apheresis Unit, Saint-Louis Hospital, Paris
| | - Tereza Coman
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris
| | - Djaouida Bengoufa
- University Paris Diderot, Sorbonne Paris Cité Immunobiology Department, Saint-Louis Hospital, Paris
| | - Anne Bergeron
- University Paris Diderot, Sorbonne Paris Cité Pneumology Department, Saint-Louis Hospital, Paris
| | - Régis Peffault de Latour
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris
| | - Martine Bagot
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité Dermatology Department, Saint-Louis Hospital, Paris
| | - Armand Bensussan
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité
| | - Gérard Socié
- University Paris Diderot, Sorbonne Paris Cité Hematology and Transplantation, Saint-Louis Hospital, Paris INSERM and UMRS1160, France
| | - Jean-David Bouaziz
- INSERM and UMRS 976, Laboratory of Onco dermatology, Immunology, and Cutaneous Stem cells, F-75739 Paris University Paris Diderot, Sorbonne Paris Cité Dermatology Department, Saint-Louis Hospital, Paris
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66
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Circulating T follicular helper cells with increased function during chronic graft-versus-host disease. Blood 2016; 127:2489-97. [PMID: 26944544 DOI: 10.1182/blood-2015-12-688895] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/24/2016] [Indexed: 12/13/2022] Open
Abstract
Chronic graft-versus-host disease (cGVHD) remains a major late complication of allogeneic hematopoietic stem cell transplantation (HSCT). Previous studies have established that both donor B and T cells contribute to immune pathology in cGVHD but the mechanisms responsible for coordinated B- and T-cell responses directed against recipient antigens have not been understood. T follicular helper cells (TFH) play an important role in the regulation of B-cell immunity. We performed extensive phenotypic and functional analysis of circulating TFH (cTFH) and B cells in 66 patients after HSCT. Patients with active cGVHD had a significantly lower frequency of cTFH compared with patients without cGVHD. This was associated with higher CXCL13 plasma levels suggesting increased homing of TFH to secondary lymphoid organs. In patients with active cGVHD, cTFH phenotype was skewed toward a highly activated profile with predominance of T helper 2 (Th2)/Th17 subsets. Activated cTFH in patients with cGVHD demonstrated increased functional ability to promote B-cell immunoglobulin secretion and maturation. Moreover, the activation signature of cTFH was highly correlated with increased B-cell activation and plasmablast maturation in patients after transplant. These studies provide new insights into the immune pathogenesis of human cGVHD and identify TFH as a key coordinating element supporting B-cell involvement in this disease.
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67
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Antibodies from donor B cells perpetuate cutaneous chronic graft-versus-host disease in mice. Blood 2016; 127:2249-60. [PMID: 26884373 DOI: 10.1182/blood-2015-09-668145] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/07/2016] [Indexed: 12/13/2022] Open
Abstract
Cutaneous sclerosis is one of the most common clinical manifestations of chronic graft-versus-host disease (cGVHD). Donor CD4(+) T and B cells play important roles in cGVHD pathogenesis, but the role of antibodies from donor B cells remains unclear. In the current studies, we generated immunoglobulin (Ig)H(µγ1) DBA/2 mice whose B cells have normal antigen-presentation and regulatory functions but cannot secrete antibodies. With a murine cGVHD model using DBA/2 donors and BALB/c recipients, we have shown that wild-type (WT) grafts induce persistent cGVHD with damage in the thymus, peripheral lymphoid organs, and skin, as well as cutaneous T helper 17 cell (Th17) infiltration. In contrast, IgH(µγ1) grafts induced only transient cGVHD with little damage in the thymus or peripheral lymph organs or with little cutaneous Th17 infiltration. Injections of IgG-containing sera from cGVHD recipients given WT grafts but not IgG-deficient sera from recipients given IgH(µγ1) grafts led to deposition of IgG in the thymus and skin, with resulting damage in the thymus and peripheral lymph organs, cutaneous Th17 infiltration, and perpetuation of cGVHD in recipients given IgH(µγ1) grafts. These results indicate that donor B-cell antibodies augment cutaneous cGVHD in part by damaging the thymus and increasing tissue infiltration of pathogenic Th17 cells.
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68
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Arai S, Pidala J, Pusic I, Chai X, Jaglowski S, Khera N, Palmer J, Chen GL, Jagasia MH, Mayer SA, Wood WA, Green M, Hyun TS, Inamoto Y, Storer BE, Miklos DB, Shulman HM, Martin PJ, Sarantopoulos S, Lee SJ, Flowers MED. A Randomized Phase II Crossover Study of Imatinib or Rituximab for Cutaneous Sclerosis after Hematopoietic Cell Transplantation. Clin Cancer Res 2015; 22:319-27. [PMID: 26378033 DOI: 10.1158/1078-0432.ccr-15-1443] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/21/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Cutaneous sclerosis occurs in 20% of patients with chronic graft-versus-host disease (GVHD) and can compromise mobility and quality of life. EXPERIMENTAL DESIGN We conducted a prospective, multicenter, randomized, two-arm phase II crossover trial of imatinib (200 mg daily) or rituximab (375 mg/m(2) i.v. weekly × 4 doses, repeatable after 3 months) for treatment of cutaneous sclerosis diagnosed within 18 months (NCT01309997). The primary endpoint was significant clinical response (SCR) at 6 months, defined as quantitative improvement in skin sclerosis or joint range of motion. Treatment success was defined as SCR at 6 months without crossover, recurrent malignancy or death. Secondary endpoints included changes of B-cell profiles in blood (BAFF levels and cellular subsets), patient-reported outcomes, and histopathology between responders and nonresponders with each therapy. RESULTS SCR was observed in 9 of 35 [26%; 95% confidence interval (CI); 13%-43%] participants randomized to imatinib and 10 of 37 (27%; 95% CI, 14%-44%) randomized to rituximab. Six (17%; 95% CI, 7%-34%) patients in the imatinib arm and 5 (14%; 95% CI, 5%-29%) in the rituximab arm had treatment success. Higher percentages of activated B cells (CD27(+)) were seen at enrollment in rituximab-treated patients who had treatment success (P = 0.01), but not in imatinib-treated patients. CONCLUSIONS These results support the need for more effective therapies for cutaneous sclerosis and suggest that activated B cells define a subgroup of patients with cutaneous sclerosis who are more likely to respond to rituximab.
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Affiliation(s)
- Sally Arai
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Iskra Pusic
- Division of Oncology, Section of Bone Marrow Transplantation, Washington University School of Medicine, St. Louis, Missouri
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Samantha Jaglowski
- Division of Hematology, Internal Medicine, Ohio State University, Columbus, Ohio
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | - George L Chen
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Madan H Jagasia
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - William A Wood
- Department of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Green
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Teresa S Hyun
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihiro Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David B Miklos
- Department of Medicine/Division of Blood and Marrow Transplant, Stanford University School of Medicine, Stanford, California
| | - Howard M Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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69
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de Masson A, Socié G, Bagot M, Bensussan A, Bouaziz JD. Deficient regulatory B cells in human chronic graft-versus-host disease. Oncoimmunology 2015; 4:e1016707. [PMID: 26140245 DOI: 10.1080/2162402x.2015.1016707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 02/03/2023] Open
Abstract
Human chronic graft-versus-host disease (cGVHD) is a frequent and disabling complication of allogeneic hematopoietic stem cell transplantation. Regulatory B cells (Bregs) are IL-10-producing B cells that are able to inhibit the innate and adaptive immune responses. We have recently demonstrated a defect in regulatory B cells in human cGVHD.
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Affiliation(s)
- Adèle de Masson
- Service de Dermatologie; Hôpital Saint-Louis ; Paris, France ; INSERM UMRS 976; Laboratoire "Oncodermatology; Immunology and Cutaneous Stem Cells"; Université Paris VII Sorbonne Paris Cité; Hôpital Saint-Louis ; Paris, France
| | - Gérard Socié
- Service d'Hématologie Greffes; INSERM UMRS 1160; Université Paris VII Sorbonne Paris Cité; Hôpital Saint-Louis ; Paris, France
| | - Martine Bagot
- Service de Dermatologie; Hôpital Saint-Louis ; Paris, France ; INSERM UMRS 976; Laboratoire "Oncodermatology; Immunology and Cutaneous Stem Cells"; Université Paris VII Sorbonne Paris Cité; Hôpital Saint-Louis ; Paris, France
| | - Armand Bensussan
- INSERM UMRS 976; Laboratoire "Oncodermatology; Immunology and Cutaneous Stem Cells"; Université Paris VII Sorbonne Paris Cité; Hôpital Saint-Louis ; Paris, France
| | - Jean-David Bouaziz
- Service de Dermatologie; Hôpital Saint-Louis ; Paris, France ; INSERM UMRS 976; Laboratoire "Oncodermatology; Immunology and Cutaneous Stem Cells"; Université Paris VII Sorbonne Paris Cité; Hôpital Saint-Louis ; Paris, France
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70
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Nakasone H, Sahaf B, Miklos DB. Therapeutic benefits targeting B-cells in chronic graft-versus-host disease. Int J Hematol 2015; 101:438-51. [PMID: 25812839 DOI: 10.1007/s12185-015-1782-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 12/21/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) can be a curative strategy for hematological diseases, and the indications for allo-HCT have broadened widely due to recent progress in supportive strategies. However, patients must overcome various complications and chronic graft-versus-host disease (cGVHD) remains the most common allo-HCT cause of long-term morbidity and mortality. cGVHD is difficult to biologically assess due to the heterogeneity of cGVHD symptoms, and the pathogenesis of cGVHD has yet to be established. Recent experimental model progress has suggested that B-cells play a critical role in cGVHD development. Consistent with these experimental results, some clinical studies investigating B-cell depletion and modulation of B-cell signaling pathways have decreased cGVHD incidence and provided some therapeutic benefit. However, randomized control studies are necessary to confirm the efficacy of B-cell targeting drugs for cGVHD. Here, we review the pathophysiology of cGVHD, especially focusing on the role of B-cell immunity, and discuss the efficacy of both B-cell depletion and modulation of B-cell signaling pathways in human cGVHD prevention, initial treatment, and salvage treatment.
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Affiliation(s)
- Hideki Nakasone
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, 269 West Campus Dr., CCSR #2205, Stanford, CA, 94305, USA
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71
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Abstract
Recent studies have compelled further interest in the potential pathological role of B cells in chronic graft-versus-host disease (cGVHD). In patients with cGVHD, B cells are activated and primed for survival via B-cell activating factor and B-cell receptor-associated pathways. Understanding the signaling pathways that drive immune pathology in cGVHD will facilitate the development of new strategies to selectively target aberrantly activated B cells and restore normal B-cell homeostasis after allogeneic stem cell transplantation.
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72
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Ramadan A, Paczesny S. Various forms of tissue damage and danger signals following hematopoietic stem-cell transplantation. Front Immunol 2015; 6:14. [PMID: 25674088 PMCID: PMC4309199 DOI: 10.3389/fimmu.2015.00014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/08/2015] [Indexed: 12/13/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is the most potent curative therapy for many malignant and non-malignant disorders. Unfortunately, a major complication of HSCT is graft-versus-host disease (GVHD), which is mediated by tissue damage resulting from the conditioning regimens before the transplantation and the alloreaction of dual immune components (activated donor T-cells and recipient’s antigen-presenting cells). This tissue damage leads to the release of alarmins and the triggering of pathogen-recognition receptors that activate the innate immune system and subsequently the adaptive immune system. Alarmins, which are of endogenous origin, together with the exogenous pathogen-associated molecular patterns (PAMPs) elicit similar responses of danger signals and represent the group of damage-associated molecular patterns (DAMPs). Effector cells of innate and adaptive immunity that are activated by PAMPs or alarmins can secrete other alarmins and amplify the immune responses. These complex interactions and loops between alarmins and PAMPs are particularly potent at inducing and then aggravating the GVHD reaction. In this review, we highlight the role of these tissue damaging molecules and their signaling pathways. Interestingly, some DAMPs and PAMPs are organ specific and GVHD-induced and have been shown to be interesting biomarkers. Some of these molecules may represent potential targets for novel therapeutic approaches.
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Affiliation(s)
- Abdulraouf Ramadan
- Department of Pediatrics, Melvin and Bren Simon Cancer Center, Indiana University , Indianapolis, IN , USA ; Department of Microbiology and Immunology, Indiana University , Indianapolis, IN , USA
| | - Sophie Paczesny
- Department of Pediatrics, Melvin and Bren Simon Cancer Center, Indiana University , Indianapolis, IN , USA ; Department of Microbiology and Immunology, Indiana University , Indianapolis, IN , USA
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