1
|
Whittaker TE, Moula SE, Bahal S, Bakri FG, Hayajneh WA, Daoud AK, Naseem A, Cavazza A, Thrasher AJ, Santilli G. Multidimensional Response Surface Methodology for the Development of a Gene Editing Protocol for p67 phox-Deficient Chronic Granulomatous Disease. Hum Gene Ther 2024; 35:298-312. [PMID: 38062734 PMCID: PMC7615834 DOI: 10.1089/hum.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Replacing a faulty gene with a correct copy has become a viable therapeutic option as a result of recent progress in gene editing protocols. Targeted integration of therapeutic genes in hematopoietic stem cells has been achieved for multiple genes using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 system and Adeno-Associated Virus (AAV) to carry a donor template. Although this is a promising strategy to correct genetic blood disorders, it is associated with toxicity and loss of function in CD34+ hematopoietic stem and progenitor cells, which has hampered clinical application. Balancing the maximum achievable correction against deleterious effects on the cells is critical. However, multiple factors are known to contribute, and the optimization process is laborious and not always clearly defined. We have developed a flexible multidimensional Response Surface Methodology approach for optimization of gene correction. Using this approach, we could rapidly investigate and select editing conditions for CD34+ cells with the best possible balance between correction and cell/colony-forming unit (CFU) loss in a parsimonious one-shot experiment. This method revealed that using relatively low doses of AAV2/6 and CRISPR/Cas9 ribonucleoprotein complex, we can preserve the fitness of CD34+ cells and, at the same time, achieve high levels of targeted gene insertion. We then used these optimized editing conditions for the correction of p67phox-deficient chronic granulomatous disease (CGD), an autosomal recessive disorder of blood phagocytic cells resulting in severe recurrent bacterial and fungal infections and achieved rescue of p67phox expression and functional correction of CD34+-derived neutrophils from a CGD patient.
Collapse
Affiliation(s)
- Thomas E. Whittaker
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Shefta E Moula
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Sameer Bahal
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Faris Ghalib Bakri
- Division of Infectious Diseases, Department of Medicine, Jordan University Hospital, Amman, Jordan
- Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
| | - Wail Ahmad Hayajneh
- Division of Infectious Diseases, Department of Pediatrics, Jordan University of Science & Technology, Irbid, Jordan
| | - Ammar Khaled Daoud
- Division of Immunology, Department of Internal Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Asma Naseem
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Alessia Cavazza
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Adrian J Thrasher
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Giorgia Santilli
- Infection, Immunity and Inflammation Teaching and Research Department, Great Ormond Street Institute of Child Health, University College London, United Kingdom
| |
Collapse
|
2
|
Srour M, Fayard A, Giannotti F, Giltat A, Guenounou S, Roy J, Schmitt J, Servais S, Alsuliman T, Agha IY, Guillerm G. [Graft failure, poor graft function erythroblastopenia: Actualization of definitions, diagnosis and treatment: Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S67-S78. [PMID: 36307323 DOI: 10.1016/j.bulcan.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
In this article, we discuss again the definition, the risk factor and guideline to treat the graft failure, the poor graft function and erythrobalstopenia. Graft failure is a severe but rare complication after hematopoietic cell transplantation (HCT). Despite disparity in the literature, we defined this complication and discussed the factor risks and recommendation for treatment based on new studies. Poor graft function is also a more frequent complication after HCT. New studies will soon be available to prove or not the current recommendation suggested in this article based on therapeutics medicine or cellular therapy. Erythroblastopenia, is a rarer complication post HCT. Despite anticipation for a better choice of compatibility donor/recipient, some patients still suffer from this complication.
Collapse
Affiliation(s)
- Micha Srour
- Hôpital Huriez, CHRU Lille, maladies du sang, rue Michel-Polonowski, 59000 Lille, France
| | - Amandine Fayard
- CHU de Clermont-Ferrand, service hématologie, 1, rue Lucie- et Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Federica Giannotti
- HUG, service hématologie, rue Gabrielle-Perret-Gentil, 4, 1205 Genève, Suisse
| | - Aurelien Giltat
- CHU d'Angers, service hématologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Sarah Guenounou
- Institut universitaire du cancer de Toulouse-Oncopole, service d'hématologie, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex, France
| | - Jean Roy
- Hématologie, 5415, boulevard de l'assomption, QC H1T 2M4 Montréal, Canada
| | - Justine Schmitt
- CHU de Liège, service d'hématologie biologique et d'immuno-hématologie, Liège, Belgique
| | - Sophie Servais
- CHU de Liège, service d'hématologie clinique, Liège, Belgique
| | - Tamim Alsuliman
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service d'hématologie, Paris, France.
| | - Ibrahim Yakoub Agha
- Université Lille, CHU de Lille, Infininite, Inserm U1286, 59000 Lille, France
| | - Gaelle Guillerm
- Hôpital Morvan, CHRU Brest, service d'hématologie, 2, avenue Foch, 29609 Brest cedex, France
| |
Collapse
|
3
|
De Ioris MA, Scarselli A, Bracaglia C, Perrotta D, Bernardi S, Santilli V, Ceglie G, Fabozzi F, Agrati C, Prencipe G, Alaggio R, Mastronuzzi A, De Vito R. Common bone marrow signature in COVID-19-associated multisystem inflammatory syndrome in children: A first-wave small case series experience. Pediatr Blood Cancer 2022; 69:e29919. [PMID: 35986692 PMCID: PMC9537984 DOI: 10.1002/pbc.29919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
The hyper-inflammatory response, also known as multisystem inflammatory syndrome in children (MIS-C), represents a major concern in children with SARS-CoV-2 infection. We report bone marrow features of three patients with MIS-C who were diagnosed during the first wave of the SARS-CoV-2 pandemic. A bone marrow evaluation was performed at onset of the inflammatory condition in order to exclude secondary hemophagocytic lymphohistiocytosis (sHLH). The bone marrows of the patients presented common features: the erythroid and megakaryocytic lineages were prominently affected and hemophagocytosis was moderately increased, differently than observed in sHLH. Megakaryocytopoiesis was increased, representing a peculiar feature of MIS-C differing from sHLH. SARS-CoV-2 RT-PCR and viral panel were studied in bone marrow aspiration samples. MIS-C is a rare complication of SARS-CoV-2 infections in children. An immuno-dysregulation considering both innate and adaptive immunity together with vascular inflammation and endothelial dysfunction play a major role. Our observations, although limited due to the small sample size, suggest that there are unique features in the bone marrow of patients with MIS-C that are likely secondary to immuno-dysregulation, and there are notable differences in bone marrow features compared to those reported in sHLH.
Collapse
Affiliation(s)
- Maria Antonietta De Ioris
- Department of Haematology/Oncology, Cell and, Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Alessia Scarselli
- Pediatric Unit, Pediatric Emergency Department (DEA)Bambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Claudia Bracaglia
- Division of Rheumatology and Laboratory of ImmunoRheumatologyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Daniela Perrotta
- Department of Anesthesia and Critical CareBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Stefania Bernardi
- Pediatric Academic DepartmentBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Veronica Santilli
- Pediatric Academic DepartmentBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Giulia Ceglie
- Department of Haematology/Oncology, Cell and, Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly,University of Tor VergataRomeItaly
| | - Francesco Fabozzi
- Department of Haematology/Oncology, Cell and, Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly,University of Tor VergataRomeItaly
| | - Chiara Agrati
- Cellular Immunology LaboratoryIRCCS National Institute for Infectious Diseases “L. Spallanzani”RomeItaly
| | - Giusi Prencipe
- Division of Rheumatology and Laboratory of ImmunoRheumatologyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Rita Alaggio
- Department of PathologyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Angela Mastronuzzi
- Department of Haematology/Oncology, Cell and, Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Rita De Vito
- Department of PathologyBambino Gesù Children's Hospital, IRCCSRomeItaly
| |
Collapse
|
4
|
Lv WR, Zhou Y, Xu J, Fan ZP, Huang F, Xu N, Xuan L, Shi PC, Liu H, Wang ZX, Sun J, Liu QF. Haploidentical donor transplant is associated with secondary poor graft function after allogeneic stem cell transplantation: A single-center retrospective study. Cancer Med 2021; 10:8497-8506. [PMID: 34668661 PMCID: PMC8633248 DOI: 10.1002/cam4.4353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background Secondary poor graft function (sPGF) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) related to poor outcome. We aimed to retrospectively evaluate the morbidity and hazard elements of sPGF after allo‐HSCT. Methods Eight hundred and sixty‐three patients who achieved initial engraftment of both neutrophils and platelets were retrospectively reviewed in this study. Results Fifty‐two patients developed sPGF within 180 days post‐transplants, with the median onset time was 62 days (range, 34–121 days) post‐transplants. The overall cumulative incidence of sPGF within 180 days post‐transplantation was 6.0%, with 3.4%, 3.4%, and 10.1%, respectively, in matched sibling donor (MSD), matched unrelated donor (MUD), and haploidentical donor (HID) transplant (p < 0.0001). Multivariable analysis showed that HID (HID vs. MSD: hazard ratio [HR] 2.525, p = 0.004; HID vs. MUD: [HR] 3.531, p = 0.017), acute graft versus host disease (aGVHD) within +30 days ([HR] 2.323, p = 0.003), and cytomegalovirus (CMV) reactivation ([HR] 8.915, p < 0.0001) within +30 days post‐transplants were hazard elements of sPGF. The patients with sPGF had poorer survival than good graft function (51.7±8.1% vs. 62.9±1.9%, p < 0.0001). Our results also showed that only CMV reactivation was the hazard element for the development of PGF in HID transplant ([HR] 12.521 p < 0.0001). Conclusion HID transplant is also an independent hazard element of sPGF except for aGVHD and CMV reactivation.
Collapse
Affiliation(s)
- Wei-Ran Lv
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ya Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Ping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Peng-Cheng Shi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Xiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi-Fa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
5
|
Müskens KF, Lindemans CA, Belderbos ME. Hematopoietic Dysfunction during Graft-Versus-Host Disease: A Self-Destructive Process? Cells 2021; 10:cells10082051. [PMID: 34440819 PMCID: PMC8392486 DOI: 10.3390/cells10082051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Graft-versus-host disease (GvHD) is a major complication of allogeneic hematopoietic (stem) cell transplantation (HCT). Clinically, GvHD is associated with severe and long-lasting hematopoietic dysfunction, which may contribute to the high mortality of GvHD after HCT. During GvHD, excessive immune activation damages both hematopoietic stem and progenitor cells and their surrounding bone marrow niche, leading to a reduction in cell number and functionality of both compartments. Hematopoietic dysfunction can be further aggravated by the occurrence—and treatment—of HCT-associated complications. These include immune suppressive therapy, coinciding infections and their treatment, and changes in the microbiome. In this review, we provide a structured overview of GvHD-mediated hematopoietic dysfunction, including the targets in the bone marrow, the mechanisms of action and the effect of GvHD-related complications and their treatment. This information may aid in the identification of treatment options to improve hematopoietic function in patients, during and after GvHD.
Collapse
Affiliation(s)
- Konradin F. Müskens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (K.F.M.); (C.A.L.)
| | - Caroline A. Lindemans
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (K.F.M.); (C.A.L.)
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
| | - Mirjam E. Belderbos
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (K.F.M.); (C.A.L.)
- Correspondence:
| |
Collapse
|
6
|
Milone G, Scirè P, Camuglia MG, Triolo A, Moschetti G, Scuderi MG, Cupri A, Milone GA, Bulla A, Giorgio MAD, Leotta V, Curtopelle A, Sciortino R, Parrinello L, Crocchiolo R, Leotta S. Low content of clonogenic progenitors on day+18 is associated with acute graft-versus-host disease and predicts transplant-related mortality. Exp Hematol 2021; 95:58-67.e4. [PMID: 33444663 DOI: 10.1016/j.exphem.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/18/2022]
Abstract
A marrow reaction associated with acute-graft-versus-host disease (a-GVHD) has been demonstrated in experimental models; its existence in human transplantation is controversial. The aim of the present study was to investigate whether clonogenic marrow precursors are an early marker for a-GVHD and transplant-related mortality (TRM). We prospectively studied 133 patients for colony-forming units-granulocyte-monocyte (CFU-GM) at day +18/+19 posttransplantation. CFU-GM frequency below the 25th percentile was predictive of an acute GVHD score I°-IV° when evaluated in multivariate logistic regression analysis (odds ratio = 13.551, 95% confidence interval [CI]: 1.583-116.031, p = 0.01). In the group with a clonogenic frequency below the 25th percentile, the cumulative incidence of GVHD grades II-IV was significantly more frequent with respect to the group with a frequency greater than the 25th percentile, 86% versus 54% (Gray test: p = 0.02). In multivariate Cox proportional analysis, a CFU-GM frequency below the 25th percentile at day +18 was associated with reduced overall survival (OS) (hazard ratio = 1.778, 95% CI: 1.022-3.093, p = 0.04). Patients with a frequency of CFU-GM greater than the 25th percentile had increased TRM with respect to patients with a clonogenic cell frequency greater than the 25th percentile (33.5% vs. 13.0%, p = 0.01). Patients were divided based on median content of viable CD34+ cells, and measurement of viable CD34+ cells was predictive for OS (p = 0.005) and TRM (p = 0.003). A weak correlation was observed between CFU-GM frequency in marrow at day +18 and levels of IL-2 receptor (IL-2R) in plasma (r = -0.226, p = 0.03). We conclude that marrow progenitor cell counts, on day +18 may be a useful marker for identifying patients at risk for severe a-GVHD, TRM, and inferior survival.
Collapse
Affiliation(s)
- Giuseppe Milone
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy; Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy.
| | - Paola Scirè
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy
| | - Maria Grazia Camuglia
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Anna Triolo
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Gaetano Moschetti
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy
| | - Maria Grazia Scuderi
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Alessandra Cupri
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Giulio Antonio Milone
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Anna Bulla
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Mary Ann Di Giorgio
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Valerio Leotta
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Angelo Curtopelle
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Roberta Sciortino
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Laura Parrinello
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Salvatore Leotta
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| |
Collapse
|
7
|
Yanir A, Schulz A, Lawitschka A, Nierkens S, Eyrich M. Immune Reconstitution After Allogeneic Haematopoietic Cell Transplantation: From Observational Studies to Targeted Interventions. Front Pediatr 2021; 9:786017. [PMID: 35087775 PMCID: PMC8789272 DOI: 10.3389/fped.2021.786017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
Immune reconstitution (IR) after allogeneic haematopoietic cell transplantation (HCT) represents a central determinant of the clinical post-transplant course, since the majority of transplant-related outcome parameters such as graft-vs.-host disease (GvHD), infectious complications, and relapse are related to the velocity, quantity and quality of immune cell recovery. Younger age at transplant has been identified as the most important positive prognostic factor for favourable IR post-transplant and, indeed, accelerated immune cell recovery in children is most likely the pivotal contributing factor to lower incidences of GvHD and infectious complications in paediatric allogeneic HCT. Although our knowledge about the mechanisms of IR has significantly increased over the recent years, strategies to influence IR are just evolving. In this review, we will discuss different patterns of IR during various time points post-transplant and their impact on outcome. Besides IR patterns and cellular phenotypes, recovery of antigen-specific immune cells, for example virus-specific T cells, has recently gained increasing interest, as certain threshold levels of antigen-specific T cells seem to confer protection against severe viral disease courses. In contrast, the association between IR and a possible graft-vs. leukaemia effect is less well-understood. Finally, we will present current concepts of how to improve IR and how this could change transplant procedures in the near future.
Collapse
Affiliation(s)
- Asaf Yanir
- Bone Marrow Transplant Unit, Division of Haematology and Oncology, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Stefan Nierkens
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Matthias Eyrich
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital, University Medical Center, University of Würzburg, Würzburg, Germany
| |
Collapse
|
8
|
Chen J, Wang H, Zhou J, Feng S. Advances in the understanding of poor graft function following allogeneic hematopoietic stem-cell transplantation. Ther Adv Hematol 2020; 11:2040620720948743. [PMID: 32874483 PMCID: PMC7436797 DOI: 10.1177/2040620720948743] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Abstract
Poor graft function (PGF) following allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is a life-threatening complication and is characterized by bilineage or trilineage blood cell deficiency and hypoplastic marrow with full chimerism. With the rapid development of allo-HSCT, especially haploidentical-HSCT, PGF has become a growing concern. The most common risk factors illustrated by recent studies include low dose of infused CD34+ cells, donor-specific antibody, cytomegalovirus infection, graft versus host disease (GVHD), iron overload and splenomegaly, among others. Because of the poor prognosis of PGF, it is crucial to uncover the underlying mechanism, which remains elusive. Recent studies have suggested that the bone marrow microenvironment may play an important role in the pathogenesis of PGF. Deficiency and dysfunction of endothelial cells and mesenchymal stem cells, elevated reactive oxygen species (ROS) levels, and immune abnormalities are believed to contribute to PGF. In this review, we also discuss recent clinical trials that evaluate the safety and efficacy of new strategies in patients with PGF. CD34+-selected stem-cell boost (SCB) is effective with an acceptable incidence of GVHD, despite the need for a second donation. Alternative strategies including the applications of mesenchymal stem cells, N-acetyl-l-cysteine (NAC), and eltrombopag have shown favorable outcomes, but further large-scale studies are needed due to the small sample sizes of the recent clinical trials.
Collapse
Affiliation(s)
- Juan Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- Center for Stem Cell Medicine, Chinese Academy of Medical Sciences and Department of Stem Cells and Regenerative Medicine, Peking Union Medical College, Tianjin, China
| | - Hongtao Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- Center for Stem Cell Medicine, Chinese Academy of Medical Sciences and Department of Stem Cells and Regenerative Medicine, Peking Union Medical College, Tianjin, China
| | - Jiaxi Zhou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China
- Center for Stem Cell Medicine, Chinese Academy of Medical Sciences and Department of Stem Cells and Regenerative Medicine, Peking Union Medical College, Tianjin, 300020, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China
- Center for Stem Cell Medicine, Chinese Academy of Medical Sciences and Department of Stem Cells and Regenerative Medicine, Peking Union Medical College, Tianjin, 300020, China
| |
Collapse
|
9
|
Tillman H, Vogel P, Rogers T, Akers W, Rehg JE. Spectrum of Posttransplant Lymphoproliferations in NSG Mice and Their Association With EBV Infection After Engraftment of Pediatric Solid Tumors. Vet Pathol 2020; 57:445-456. [PMID: 32202225 PMCID: PMC7478125 DOI: 10.1177/0300985820913265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pediatric patients receiving solid organ transplants may develop lymphoproliferative diseases, including graft-versus-host disease (GvHD) and posttransplant lymphoproliferative diseases (PTLDs). We characterized lesions in 11 clinically ill NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice that received pediatric-patient-derived solid tumors (PDXs) and developed immunodeficiency-associated lymphoproliferations comparable to GvHD and PTLDs over a period of 46 to 283 days after implantation. Lymphoproliferations were diffusely positive for human-specific biomarkers, including NUMA1, CD45, and CD43, but lacked immunoreactivity for murine CD45. Human immune cells were CD3-positive, with subsets having immunoreactivity for CD4 and CD8 as well as PAX5, CD79a, and IRF4, resulting from populations of human T and B cells present within the xenotransplants. Tissues and organs infiltrated included mucocutaneous zones (oral cavity and perigenital and perianal regions), haired skin, tongue, esophagus, forestomach, thyroid, salivary glands, lungs, liver, kidneys, spleen, lymph nodes, bone marrow, and brain. In 4 of 5 mice with PTLD, Epstein-Barr virus (EBV)-encoded small RNAs (EBERs) were detected by in situ hybridization in PAX5+ human B cells associated with the PDX (n = 1/4) or with engrafted human immune cells at other anatomic locations (n = 4/11). One of the 4 mice had an EBV-associated human large B-cell lymphoma. NSG mice receiving xenotransplants can develop combinations of GvHD, EBV-driven PTLD, and B-cell lymphoma similar to those occurring in human pediatric patients. Therefore, pediatric xenotransplants should undergo histopathologic and immunohistochemical assessment upon collection to ensure that the specimen is not a lymphoma and does not contain lymphoma cells because these neoplasms can morphologically mimic small round blue cell pediatric solid tumors.
Collapse
Affiliation(s)
- Heather Tillman
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Peter Vogel
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tiffani Rogers
- Animal Resources Center, St. Jude Children's Research Hospital, Memphis, TN
| | - Walter Akers
- Center for In Vivo Imaging and Therapeutics, St Jude Children’s Research Hospital, Memphis, TN
| | - Jerold E. Rehg
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
10
|
Ding L, Ning HM, Li PL, Yan HM, Han DM, Zheng XL, Liu J, Zhu L, Xue M, Mao N, Guo ZK, Zhu H, Wang HX. Tumor necrosis factor α in aGVHD patients contributed to the impairment of recipient bone marrow MSC stemness and deficiency of their hematopoiesis-promotion capacity. Stem Cell Res Ther 2020; 11:119. [PMID: 32183881 PMCID: PMC7079531 DOI: 10.1186/s13287-020-01615-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Though accumulated evidence has demonstrated visceral organ involvement in acute graft-versus-host disease (aGVHD), how aGVHD influences the bone marrow (BM) niche and the reconstitution of hematopoiesis post-hematopoietic stem cell transplantation remains largely unknown. Methods In the current study, the cell morphology, immunophenotype, multi-differentiation capacity, self-renewal capacity, and hematopoiesis promotion of the MSCs from aGVHD and non-aGVHD patients were investigated. Additionally, the stemness and hematopoiesis-promoting property of healthy donor-derived MSCs were evaluated in the presence of BM supernatant from aGVHD patients. Mechanistically, antibodies targeting inflammatory cytokines involved in aGVHD were added into the MSC culture. Furthermore, a recombinant human tumor necrosis factor (TNF-α) receptor-Ig fusion protein (rhTNFR:Fc) was used to protect healthy donor-derived MSCs. Moreover, mRNA sequencing was performed to explore the underlying mechanisms. Results The aGVHD MSCs exhibited morphological and immunophenotypic characteristics that were similar to those of the non-aGVHD MSCs. However, the osteogenic and adipogenic activities of the aGVHD MSCs significantly decreased. Additionally, the colony formation capacity and the expression of self-renewal-related genes remarkably decreased in aGVHD MSCs. Further, the hematopoiesis-supporting capacity of aGVHD MSCs significantly reduced. The antibody neutralization results showed that TNF-α contributed to the impairment of MSC properties. Moreover, rhTNFR:Fc exhibited notable protective effects on MSCs in the aGVHD BM supernatants. The mRNA sequencing results indicated that the TNF-α pathway and the Toll-like receptor pathway may be activated by TNF-α. Conclusions Thus, our data demonstrate MSCs as cellular targets of aGVHD and suggest a potential role of TNF-α blockage in maintaining the BM niche of aGVHD patients.
Collapse
Affiliation(s)
- Li Ding
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China.,Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, People's Republic of China
| | - Hong-Mei Ning
- The Fifth Medical Center of Chinese PLA General Hospital, East Street 8, Beijing, 100071, People's Republic of China
| | - Pei-Lin Li
- Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, People's Republic of China
| | - Hong-Min Yan
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Dong-Mei Han
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Xiao-Li Zheng
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Jing Liu
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Ling Zhu
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Mei Xue
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China
| | - Ning Mao
- Beijing Institute of Basic Medical Sciences, Road Taiping 27, Beijing, 100850, People's Republic of China
| | - Zi-Kuan Guo
- Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, People's Republic of China.
| | - Heng Zhu
- Beijing Institute of Radiation Medicine, Road Taiping 27, Beijing, 100850, People's Republic of China.
| | - Heng-Xiang Wang
- Medical Center of Air Forces, PLA, Road Fucheng 30, Beijing, 100142, People's Republic of China.
| |
Collapse
|
11
|
Törlén J, Gaballa A, Remberger M, Mörk LM, Sundberg B, Mattsson J, Uhlin M. Effect of Graft-versus-Host Disease Prophylaxis Regimens on T and B Cell Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1260-1268. [DOI: 10.1016/j.bbmt.2019.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
|
12
|
Virus reactivation and low dose of CD34+ cell, rather than haploidentical transplantation, were associated with secondary poor graft function within the first 100 days after allogeneic stem cell transplantation. Ann Hematol 2019; 98:1877-1883. [DOI: 10.1007/s00277-019-03715-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/06/2019] [Indexed: 12/17/2022]
|
13
|
Cao XN, Kong Y, Song Y, Shi MM, Zhao HY, Wen Q, Lyu ZS, Duan CW, Wang Y, Xu LP, Zhang XH, Huang XJ. Impairment of bone marrow endothelial progenitor cells in acute graft-versus-host disease patients after allotransplant. Br J Haematol 2018; 182:870-886. [PMID: 29984829 DOI: 10.1111/bjh.15456] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Xie-Na Cao
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Yuan Kong
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Yang Song
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Min-Min Shi
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
- Peking-Tsinghua Center for Life Sciences; Academy for Advanced Interdisciplinary Studies; Peking University; Beijing China
| | - Hong-Yan Zhao
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Qi Wen
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Zhong-Shi Lyu
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
- Peking-Tsinghua Center for Life Sciences; Academy for Advanced Interdisciplinary Studies; Peking University; Beijing China
| | - Cai-Wen Duan
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health and Pediatric Translational Medicine Institute; Shanghai Children's Medical Center; Shanghai Collaborative Innovation Center for Translational Medicine and Department of Pharmacology and Chemical Biology; Shanghai Jiao Tong University School of medicine; Shanghai China
| | - Yu Wang
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Lan-Ping Xu
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Xiao-Hui Zhang
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
| | - Xiao-Jun Huang
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Collaborative Innovation Center of Hematology; Peking University; Beijing China
- Peking-Tsinghua Center for Life Sciences; Academy for Advanced Interdisciplinary Studies; Peking University; Beijing China
| |
Collapse
|
14
|
Recovery of Donor Hematopoiesis after Graft Failure and Second Hematopoietic Stem Cell Transplantation with Intraosseous Administration of Mesenchymal Stromal Cells. Stem Cells Int 2018; 2018:6495018. [PMID: 29760731 PMCID: PMC5914104 DOI: 10.1155/2018/6495018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 01/22/2023] Open
Abstract
Multipotent mesenchymal stromal cells (MSCs) participate in the formation of bone marrow niches for hematopoietic stem cells. Donor MSCs can serve as a source of recovery for niches in patients with graft failure (GF) after allogeneic bone marrow (BM) transplantation. Since only few MSCs reach the BM after intravenous injection, MSCs were implanted into the iliac spine. For 8 patients with GF after allo-BMT, another hematopoietic stem cell transplantation with simultaneous implantation of MSCs from their respective donors into cancellous bone was performed. BM was aspirated from the iliac crest of these patients at 1-2, 4-5, and 9 months after the intraosseous injection of donor MSCs. Patients' MSCs were cultivated, and chimerism was determined. In 6 out of 8 patients, donor hematopoiesis was restored. Donor cells (9.4 ± 3.3%) were detected among MSCs. Thus, implanted MSCs remain localized at the site of administration and do not lose the ability to proliferate. These results suggest that MSCs could participate in the restoration of niches for donor hematopoietic cells or have an immunomodulatory effect, preventing repeated rejection of the graft. Perhaps, intraosseous implantation of MSCs contributes to the success of the second transplantation of hematopoietic stem cells and patient survival.
Collapse
|
15
|
Rezende BM, Athayde RM, Gonçalves WA, Resende CB, Teles de Tolêdo Bernardes P, Perez DA, Esper L, Reis AC, Rachid MA, Castor MGME, Cunha TM, Machado FS, Teixeira MM, Pinho V. Inhibition of 5-lipoxygenase alleviates graft-versus-host disease. J Exp Med 2017; 214:3399-3415. [PMID: 28947611 PMCID: PMC5679175 DOI: 10.1084/jem.20170261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/24/2017] [Accepted: 08/18/2017] [Indexed: 01/26/2023] Open
Abstract
Rezende et al. report that the transplant of 5-lipoxygenase (5-LO)−deficient leukocytes protects mice from GVHD. Treatment with the 5-LO inhibitor zileuton or a LTB4 antagonist at the initial phase of the transplant achieves similar protective effects. 5-LO is a crucial contributor to tissue damage in GVHD. Leukotriene B4 (LTB4), a proinflammatory mediator produced by the enzyme 5-lipoxygenase (5-LO), is associated with the development of many inflammatory diseases. In this study, we evaluated the participation of the 5-LO/LTB4 axis in graft-versus-host disease (GVHD) pathogenesis by transplanting 5-LO–deficient leukocytes and investigated the effect of pharmacologic 5-LO inhibition by zileuton and LTB4 inhibition by CP-105,696. Mice that received allogeneic transplant showed an increase in nuclear 5-LO expression in splenocytes, indicating enzyme activation after GVHD. Mice receiving 5-LO–deficient cell transplant or zileuton treatment had prolonged survival, reduced GVHD clinical scores, reduced intestinal and liver injury, and decreased levels of serum and hepatic LTB4. These results were associated with inhibition of leukocyte recruitment and decreased production of cytokines and chemokines. Treatment with CP-105,696 achieved similar effects. The chimerism or the beneficial graft-versus-leukemia response remained unaffected. Our data provide evidence that the 5-LO/LTB4 axis orchestrates GVHD development and suggest it could be a target for the development of novel therapeutic strategies for GVHD treatment.
Collapse
Affiliation(s)
- Barbara Maximino Rezende
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Rayssa Maciel Athayde
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - William Antônio Gonçalves
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Carolina Braga Resende
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Priscila Teles de Tolêdo Bernardes
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Denise Alves Perez
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Lísia Esper
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Alesandra Côrte Reis
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Milene Alvarenga Rachid
- Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Marina Gomes Miranda E Castor
- Departamento de Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Thiago Mattar Cunha
- Departamento de Farmacologia, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Fabiana Simão Machado
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Mauro Martins Teixeira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Vanessa Pinho
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| |
Collapse
|
16
|
Abstract
: Graft-versus-host disease (GVHD) is a major complication that occurs following allogeneic hematopoietic stem cell transplantation, which is a potential curative therapy used in a variety of malignant or benign hematological diseases. Graft-versus-host disease primarily occurs in many organs, but most notably in the skin, lungs, gastrointestinal tract, liver, eyes, mucosa, and musculoskeletal system. Ocular manifestations of GVHD may precede other systemic GVHD findings, and it may be a poor prognosis for mortality. While all parts of the eye may be affected, ocular GVHD occurs primarily in the ocular surface. Dry eye disease or keratoconjunctivitis sicca is the most common presenting manifestation of chronic ocular GVHD. Dry eye disease in ocular GVHD is a multifactorial process, which involves destruction and fibrosis of lacrimal glands and conjunctiva, leading to tear film deficiency and instability. Depending on the severity of ocular involvement and response to treatment, ocular GVHD may cause decreased quality of life. Management of GVHD begins with prevention by understanding risk factors and by implementing prophylactic treatment after allogeneic hematopoietic stem cell transplantation. A multidisciplinary approach to the prevention and treatment of GVHD is important, and there are currently no preventive therapies available for ocular GVHD. Once diagnosed, ocular GVHD treatment strategies target ocular surface lubrication and support, tear film stabilization, inflammation reduction, and surgical intervention. The goal of this review is to define ocular GVHD and its categorical manifestations, as well as to describe the importance of comprehensive assessment, diagnosis, and ophthalmologic treatment and management of ocular GVHD with a multidisciplinary approach.
Collapse
|
17
|
Barroeta Seijas AB, Simonetti S, Vitale S, Runci D, Quinci AC, Soriani A, Criscuoli M, Filippi I, Naldini A, Sacchetti FM, Tarantino U, Oliva F, Piccirilli E, Santoni A, Di Rosa F. GM-CSF Inhibits c-Kit and SCF Expression by Bone Marrow-Derived Dendritic Cells. Front Immunol 2017; 8:147. [PMID: 28261209 PMCID: PMC5311071 DOI: 10.3389/fimmu.2017.00147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/30/2017] [Indexed: 01/20/2023] Open
Abstract
Stem cell factor (SCF), the ligand of c-kit, is a key cytokine for hematopoiesis. Hematopoietic precursors express c-kit, whereas differentiated cells of hematopoietic lineage are negative for this receptor, with the exception of NK cells, mast cells, and a few others. While it has long been recognized that dendritic cells (DCs) can express c-kit, several questions remain concerning the SCF/c-kit axis in DCs. This is particularly relevant for DCs found in those organs wherein SCF is highly expressed, including the bone marrow (BM). We characterized c-kit expression by conventional DCs (cDCs) from BM and demonstrated a higher proportion of c-kit+ cells among type 1 cDC subsets (cDC1s) than type 2 cDC subsets (cDC2s) in both humans and mice, whereas similar levels of c-kit expression were observed in cDC1s and cDC2s from mouse spleen. To further study c-kit regulation, DCs were generated with granulocyte-macrophage colony-stimulating factor (GM-CSF) from mouse BM, a widely used protocol. CD11c+ cells were purified from pooled non-adherent and slightly adherent cells collected after 7 days of culture, thus obtaining highly purified BM-derived DCs (BMdDCs). BMdDCs contained a small fraction of c-kit+ cells, and by replating them for 2 days with GM-CSF, we obtained a homogeneous population of c-kit+ CD40hi MHCIIhi cells. Not only did BMdDCs express c-kit but they also produced SCF, and both were striking upregulated if GM-CSF was omitted after replating. Furthermore, a small but significant reduction in BMdDC survival was observed upon SCF silencing. Incubation of BMdDCs with SCF did not modulate antigen presentation ability of these cells, nor it did regulate their membrane expression of the chemokine receptor CXCR4. We conclude that the SCF/c-kit-mediated prosurvival circuit may have been overlooked because of the prominent use of GM-CSF in DC cultures in vitro, including those human DC cultures destined for the clinics. We speculate that DCs more prominently rely on SCF in vivo in some microenvironments, with potential implications for graft-versus-host disease and antitumor immunity.
Collapse
Affiliation(s)
- Amairelys Belen Barroeta Seijas
- Institute of Molecular Biology and Pathology, National Research Council (CNR), c/o Department of Molecular Medicine, University of Rome "Sapienza", Rome, Italy; Department of Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| | - Sonia Simonetti
- Department of Molecular Medicine, University of Rome "Sapienza" , Rome , Italy
| | - Sara Vitale
- Institute of Molecular Biology and Pathology, National Research Council (CNR), c/o Department of Molecular Medicine, University of Rome "Sapienza" , Rome , Italy
| | - Daniele Runci
- Istituto Pasteur Italia - Fondazione Cenci Bolognetti , Rome , Italy
| | | | - Alessandra Soriani
- Department of Molecular Medicine, University of Rome "Sapienza" , Rome , Italy
| | - Mattia Criscuoli
- Department of Molecular and Developmental Medicine, University of Siena , Siena , Italy
| | - Irene Filippi
- Department of Molecular and Developmental Medicine, University of Siena , Siena , Italy
| | - Antonella Naldini
- Department of Molecular and Developmental Medicine, University of Siena , Siena , Italy
| | | | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata" , Rome , Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata" , Rome , Italy
| | - Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata" , Rome , Italy
| | - Angela Santoni
- Department of Molecular Medicine, University of Rome "Sapienza", Rome, Italy; Istituto Pasteur Italia - Fondazione Cenci Bolognetti, Rome, Italy
| | - Francesca Di Rosa
- Institute of Molecular Biology and Pathology, National Research Council (CNR), c/o Department of Molecular Medicine, University of Rome "Sapienza" , Rome , Italy
| |
Collapse
|
18
|
Conditioning with Fludarabine-Busulfan versus Busulfan-Cyclophosphamide Is Associated with Lower aGVHD and Higher Survival but More Extensive and Long Standing Bone Marrow Damage. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3071214. [PMID: 27843940 PMCID: PMC5098055 DOI: 10.1155/2016/3071214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/15/2016] [Accepted: 09/18/2016] [Indexed: 11/18/2022]
Abstract
Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a major cause of nonrelapse mortality after allo-HSCT. A conditioning regimen plays a pivotal role in the development of aGVHD. To provide a platform for studying aGVHD and evaluating the impact of different conditioning regimens, we established a murine aGVHD model that simulates the clinical situation and can be conditioned with Busulfan-Cyclophosphamide (Bu-Cy) and Fludarabine-Busulfan (Flu-Bu). In our study, BALB/c mice were conditioned with Bu-Cy or Flu-Bu and transplanted with 2 × 107 bone marrow cells and 2 × 107 splenocytes from either allogeneic (C57BL/6) or syngeneic (BALB/c) donors. The allogeneic recipients conditioned with Bu-Cy had shorter survivals (P < 0.05), more severe clinical manifestations, and higher hepatic and intestinal pathology scores, associated with increased INF-γ expression and diminished IL-4 expression in serum, compared to allogeneic recipients conditioned with Flu-Bu. Moreover, higher donor-derived T-cell infiltration and severely impaired B-cell development were seen in the bone marrow of mice, exhibiting aGVHD and conditioned with Flu-Bu. Our study showed that the conditioning regimen with Bu-Cy resulted in more severe aGVHD while the Flu-Bu regimen was associated with more extensive and long standing bone marrow damage.
Collapse
|
19
|
Medinger M, Krenger W, Jakab A, Halter J, Buser A, Bucher C, Passweg J, Tzankov A. Numerical impairment of nestin(+) bone marrow niches in acute GvHD after allogeneic hematopoietic stem cell transplantation for AML. Bone Marrow Transplant 2015; 50:1453-8. [PMID: 26301968 DOI: 10.1038/bmt.2015.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 01/12/2023]
Abstract
The nestin(+) perivascular bone marrow (BM) stem cell niche (N(+)SCN) may be involved in GvHD. To investigate whether acute GvHD (aGvHD) reduces the number of N(+)SCN, we examined patients with AML who had undergone allogeneic hematopoietic stem cell transplantation. In the test cohort (n=8), the number of N(+)SCN per mm(2) in BM biopsies was significantly reduced in aGvHD patients at the time of aGvHD compared with patients who did not have aGvHD (1.2±0.78 versus 2.6±0.93, P=0.04). In the validation cohort (n=40), the number of N(+)SCN was reduced (1.9±0.99 versus 2.6±0.90 N(+)SCN/mm(2), P=0.05) in aGvHD patients. Receiver operating curves suggested that the cutoff score that best discriminated between patients with and without aGvHD was 2.29 N(+)SCN/mm(2). Applying this cutoff score, 9/11 patients with clinically relevant aGvHD (⩾grade 2) and 13/20 with any type of GvHD had decreased N(+)SCN numbers compared with only 10/29 patients without clinically relevant aGvHD (P=0.007) and 6/20 patients without any type of GvHD (P=0.028). In patients tracked over time, N(+)SCN density returned to normal after aGvHD resolved or remained stable in patients who did not have aGvHD. Our results show a decrease in the number of N(+)SCN in aGvHD.
Collapse
Affiliation(s)
- M Medinger
- Hematology, University Hospital Basel, Basel, Switzerland
| | - W Krenger
- GMP Facility, University Hospital Basel, Basel, Switzerland
| | - A Jakab
- Hematology, University Hospital Basel, Basel, Switzerland
| | - J Halter
- Hematology, University Hospital Basel, Basel, Switzerland
| | - A Buser
- Hematology, University Hospital Basel, Basel, Switzerland
| | - C Bucher
- Hematology, University Hospital Basel, Basel, Switzerland
| | - J Passweg
- Hematology, University Hospital Basel, Basel, Switzerland
| | - A Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
20
|
Gauthier SD, Leboeuf D, Manuguerra-Gagné R, Gaboury L, Guimond M. Stromal-Derived Factor-1α and Interleukin-7 Treatment Improves Homeostatic Proliferation of Naïve CD4(+) T Cells after Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1721-31. [PMID: 26151303 DOI: 10.1016/j.bbmt.2015.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/30/2015] [Indexed: 11/19/2022]
Abstract
Graft-versus-host disease (GVHD) impairs immune reconstitution after allogeneic stem cell transplantation (allo-SCT) and effective therapies aimed at restoring T cell counts in GVHD patients have yet to be developed. During GVHD, CD4(+) T cell reconstitution is particularly affected and current models hold that GVHD insult to the peripheral lymphoid niche is responsible for this effect. Here, we show that naïve CD4(+) T cell homeostatic proliferation (HP) is lost during GVHD because of low systemic IL-7 and impaired dendritic cell (DC) regeneration. We assessed factors involved in DC differentiation and found that although fms-like tyrosine kinase 3 ligand (Flt3-L) levels were normal, stromal-derived factor-1α (SDF-1α) was diminished in the blood of GVHD mice. Unlike Flt3-L treatment, the administration of SDF-1α specifically increased CD8α(+) DC numbers and did not worsen GVHD. Importantly, CD4(+) T cell HP was enhanced only when IL-7 and SDF-1α or Flt3L were coadministered, confirming the crucial role of DCs and IL-7 in restoring CD4(+) T cell regeneration during GVHD. Altogether, our results indicate that CD8α(+) DCs are part of the peripheral niche that controls CD4(+) T cell HP and that their depletion, combined with low systemic IL-7, explains how GVHD constrains naïve CD4(+) T cell reconstitution after allo-SCT.
Collapse
Affiliation(s)
- Simon-David Gauthier
- Department of Hematology-Oncology, Maisonneuve-Rosemont Hospital Research Center, Montréal, Québec, Canada; Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Dominique Leboeuf
- Department of Hematology-Oncology, Maisonneuve-Rosemont Hospital Research Center, Montréal, Québec, Canada
| | - Renaud Manuguerra-Gagné
- Department of Hematology-Oncology, Maisonneuve-Rosemont Hospital Research Center, Montréal, Québec, Canada
| | - Louis Gaboury
- Department of Pathology, Institute for Research in Immunology and Cancer, Montréal, Québec, Canada
| | - Martin Guimond
- Department of Hematology-Oncology, Maisonneuve-Rosemont Hospital Research Center, Montréal, Québec, Canada; Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
21
|
|