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Sato S, Ogawa Y, Shimizu E, Asai K, Okazaki T, Rusch R, Hirayama M, Shimmura S, Negishi K, Tsubota K. Cellular senescence promotes meibomian gland dysfunction in a chronic graft-versus-host disease mouse model. Ocul Surf 2024; 32:198-210. [PMID: 38499288 DOI: 10.1016/j.jtos.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/27/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Aging is a well-established risk factor for meibomian gland dysfunction (MGD). We previously reported an accelerated cellular senescence phenomenon in the lacrimal glands of a murine model of chronic graft-versus-host disease (cGVHD). Herein, we aimed to elucidate the relationship between cellular senescence and MGD in cGVHD mice, utilizing the senolytic agent ABT-263. METHODS A cGVHD mouse model was established through allogeneic bone marrow transplantation (BMT) from B10.D2 to BALB/c mice. Subsequently, cGVHD mice were treated with either ABT-263 or vehicle. The eyelids of recipients were analyzed at 4-week intervals post-BMT in both groups. RESULTS Meibomian gland (MG) area was significantly smaller in cGVHD mice than in syngeneic control mice. ABT-263-treated mice retained a significantly larger MG area than their vehicle-treated counterparts. Pathological and immunohistochemical examinations revealed significant reductions in eyelid tissue inflammation and pathological fibrosis in the ABT-263 group compared to that in the vehicle-treated group. Additionally, expression of DNA damage markers, senescent cell markers, and senescence-associated secretory phenotype (SASP) factors was elevated in the eyelids of cGVHD mice compared with that in syngeneic mice. The expression of these cellular senescence-associated molecules was considerably suppressed in ABT-263-treated eyelids compared to that in vehicle-treated ones. CONCLUSIONS Cellular senescence, along with expression of SASP factors, exhibited increased activity in the eyelids, particularly in the MGs of cGVHD mice. ABT-263 mitigated the severity of MGD. These findings highlight the potential of targeting cellular senescence as an effective approach for MGD treatment in cGVHD.
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Affiliation(s)
- Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Asai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Okazaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Robert Rusch
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Hirayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Fujita Medical Innovation Center Tokyo, Fujita Health University, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Hollond CS, Ganti A, Streich-Tilles T, Debiec K, Galloway A, Inneh O, Cizek S. Adolescent and Young Adult Patients with Vaginal Graft-vs-Host Disease and Hematocolpos Managed with Vaginal Stents: A Case Series. J Pediatr Adolesc Gynecol 2024; 37:78-86. [PMID: 37797789 DOI: 10.1016/j.jpag.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Abstract
STUDY OBJECTIVE Vaginal stenosis can be acquired as a result of vaginal graft-vs-host disease (GVHD) in patients who have undergone hematopoietic stem cell transplant (HSCT). Little data exist to guide the management of vaginal GVHD, particularly in adolescent and young adult patients. The objective of this study was to detail the management of vaginal stenosis with lysis of adhesions and vaginal stent placement in 3 young patients with vaginal GVHD. METHODS A retrospective chart review was done for 3 patients with vaginal GVHD causing vaginal stenosis with hematometrocolpos. All 3 were treated using vaginal stent placement. Additionally, a literature review was conducted through PubMed and Google Scholar to identify 21 case reports (with a total of 35 patients) of menstrual obstruction due to GVHD. RESULTS Obstructive vaginal stenosis secondary to vaginal GVHD occurred in our patients at ages 15, 16, and 24 years. Resolution of hematocolpos was obtained with lysis of vaginal adhesions with vaginal stent placement in all patients, with varying regimens of systemic and topical hormones, topical corticosteroids, and dilator therapy. DISCUSSION Vaginal stenosis secondary to vaginal GVHD should be considered in patients with a history of allogeneic HSCT presenting with amenorrhea, especially those with a diagnosis of primary ovarian insufficiency. The use of vaginal stents, along with postoperative medical and dilator management as appropriate, may prevent re-stenosis, although more information is needed regarding the efficacy of treatments.
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Affiliation(s)
| | - Amitha Ganti
- Department of OB/GYN, Division of Pediatric and Adolescent Gynecology, Stanford University School of Medicine, Stanford, California
| | - Tara Streich-Tilles
- Department of Surgery, Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kate Debiec
- Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, University of Washington and Seattle Children's, Seattle, Washington
| | | | - Oyenmwen Inneh
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie Cizek
- Department of OB/GYN, Division of Pediatric and Adolescent Gynecology, Stanford University School of Medicine, Stanford, California.
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Hp C, Harjai G, Doddawad VG, S M. Comprehensive Preventive and Therapeutic Oral Health Care: A Case Report of Mucopolysaccharidosis Type IV A in a Pediatric Patient. P R Health Sci J 2023; 42:332-334. [PMID: 38104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Mucopolysaccharidosis (MPS) is a metabolic disorder resulting from a deficiency of lysosomal enzymes. It is an autosomal recessive disorder with similar incidences in men and women. Mucopolysaccharidosis type IV A is caused by a deficiency of N-acetylgalactosamine-6-sulfatase, which deficiency is, in turn, caused by alterations in the GALNS gene. It is marked by a short stature, a pigeon chest, frontal bossing, kyphosis, and a flat nasal bridge. Intraorally, macroglossia, hypodontia, dentinogenesis imperfecta, a broad mouth, and an anterior open bite are some of the common features. The present paper reports on a case of MPS in a 5-year-old male patient, along with providing a review of the literature and insight into the oral manifestations related to MPS IV A, also called Morquio A syndrome, and its dental treatment. It aims to highlight the clinical recommendations for oral health care in such cases during different phases of MPS IV A treatment.
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Affiliation(s)
- Chanchala Hp
- Assistant Professor, Department of Paediatric and Preventive Dentistry, JSS Dental College and Hospital, A constituent college of the JSS Academy of Higher Education & Research, Karnataka, India
| | - Gunica Harjai
- Postgraduate, Department of Paediatric and Preventive Dentistry, JSS Dental College and Hospital, A constituent college of the JSS Academy of Higher Education & Research, Karnataka, India
| | - Vidya G Doddawad
- Associate Professor, Department of Oral Pathology and Microbiology, JSS Dental College and Hospital, A constituent college of the JSS Academy of Higher Education & Research, Karnataka, India
| | - Manjual S
- Associate professor, Department of Oral and Maxillo Facial Surgery, JSS Dental College and Hospital, A constituent college of the JSS Academy of Higher Education & Research, Karnataka, India
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Liang TZ, Dong S, Fang M, Gong Y, Yaghmour G, Chopra S. Hepatitic Variant of Graft-vs-Host Disease. Am J Clin Pathol 2022; 157:948-955. [PMID: 35038720 DOI: 10.1093/ajcp/aqab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Graft-vs-host disease (GVHD) of the liver is a complication of allogeneic hematopoietic stem cell transplantation with hepatitic and classic variants. We determined the percentage of hepatitic variant cases, compared clinicopathologic features of the two groups, and assessed prognostic factors. METHODS Fifty liver biopsy specimens from 40 patients with GVHD were studied. RESULTS Fifteen (30%) cases had moderate to marked lobular inflammation and were classified as a hepatitic variant. Bile duct damage was present in all cases. Ductular reaction, apoptosis. and endotheliitis were more commonly seen in the hepatitic variant. Hepatocyte ballooning was an independent poor prognostic factor. The median aspartate aminotransferase and alanine aminotransferase were higher in the hepatitic variant while alkaline phosphatase and bilirubin were higher in the classic group. Forty (80%) GVHD cases were more than 100 days after transplant, correlating to immunosuppression taper. There was response to treatment with increased immunosuppression in both groups, but time to normalization of liver function tests was higher in the hepatitic variant. CONCLUSIONS Bile duct damage was the most consistent pathologic finding in our cohort and was present in all cases of GVHD. Moderate to marked lobular inflammation can be seen in GVHD in up to 30% of cases without any other coexisting cause. Hepatocyte ballooning is an independent poor prognostic factor.
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Affiliation(s)
- Tom Z Liang
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - Stephen Dong
- Department of Medicine, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - Mike Fang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Yuna Gong
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - George Yaghmour
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Shefali Chopra
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
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Cueto Sarmiento KY, Baquero Rey JA, Andrade Miranda A, Bruey SA, Makiya ML, Mazzuoccolo LD, Enz PA. Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease. Actas Dermosifiliogr (Engl Ed) 2021:S1578-2190(21)00177-3. [PMID: 34078587 DOI: 10.1016/j.adengl.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS We included all pediatric patients with acute or chronic GVHD treated with ECP by the dermatology department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION ECP is a good treatment option for pediatric patients with acute or chronic GVHD.
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Affiliation(s)
- K Y Cueto Sarmiento
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J A Baquero Rey
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Andrade Miranda
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S A Bruey
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M L Makiya
- Equipo de Trasplante de Médula Ósea Pediátrico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L D Mazzuoccolo
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P A Enz
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Cueto Sarmiento KY, Baquero Rey JA, Andrade Miranda A, Bruey SA, Makiya ML, Mazzuoccolo LD, Enz PA. Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00088-0. [PMID: 33621559 DOI: 10.1016/j.ad.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION ECP is a good treatment option for pediatric patients with acute or chronic GVHD.
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Affiliation(s)
- K Y Cueto Sarmiento
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J A Baquero Rey
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Andrade Miranda
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S A Bruey
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M L Makiya
- Equipo de Trasplante de Médula Ósea Pediátrico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L D Mazzuoccolo
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P A Enz
- Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Quach DH, Becerra-Dominguez L, Rouce RH, Rooney CM. A strategy to protect off-the-shelf cell therapy products using virus-specific T-cells engineered to eliminate alloreactive T-cells. J Transl Med 2019; 17:240. [PMID: 31340822 PMCID: PMC6657103 DOI: 10.1186/s12967-019-1988-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022] Open
Abstract
Background The use of “off-the-shelf” cellular therapy products derived from healthy donors addresses many of the challenges associated with customized cell products. However, the potential of allogeneic cell products to produce graft-versus-host disease (GVHD), and their likely rejection by host alloreactive T-cells are major barriers to their clinical safety and efficacy. We have developed a molecule that when expressed in T-cells, can eliminate alloreactive T-cells and hence can be used to protect cell therapy products from allospecific rejection. Further, expression of this molecule in virus-specific T-cells (VSTs) should virtually eliminate the potential for recipients to develop GVHD. Methods To generate a molecule that can mediate killing of cognate alloreactive T-cells, we fused beta-2 microglobulin (B2M), a universal component of all human leukocyte antigen (HLA) class I molecules, to the cytolytic endodomain of the T cell receptor ζ chain, to create a chimeric HLA accessory receptor (CHAR). To determine if CHAR-modified human VSTs could eliminate alloreactive T-cells, we co-cultured them with allogeneic peripheral blood mononuclear cells (PBMC), and assessed proliferation of PBMC-derived alloreactive T-cells and the survival of CHAR-modified VSTs by flow cytometry. Results The CHAR was able to transport HLA molecules to the cell surface of Daudi cells, that lack HLA class I expression due to defective B2M expression, illustrating its ability to complex with human HLA class I molecules. Furthermore, VSTs expressing CHAR were protected from allospecific elimination in co-cultures with allogeneic PBMCs compared to unmodified VSTs, and mediated killing of alloreactive T-cells. Unexpectedly, CHAR-modified VSTs eliminated not only alloreactive HLA class I restricted CD8 T-cells, but also alloreactive CD4 T-cells. This beneficial effect resulted from non-specific elimination of activated T-cells. Of note, we confirmed that CHAR-modified VSTs did not affect pathogen-specific T-cells which are essential for protective immunity. Conclusions Human T-cells can be genetically modified to eliminate alloreactive T-cells, providing a unique strategy to protect off-the-shelf cell therapy products. Allogeneic cell therapies have already proved effective in treating viral infections in the stem cell transplant setting, and have potential in other fields such as regenerative medicine. A strategy to prevent allograft rejection would greatly increase their efficacy and commercial viability. Electronic supplementary material The online version of this article (10.1186/s12967-019-1988-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David H Quach
- Center for Cell and Gene Therapy, Texas Children's Hospital, Houston Methodist Hospital and Baylor College of Medicine, 1102 Bates Ave, Suite 1770, Houston, TX, 77030, USA
| | - Luis Becerra-Dominguez
- Center for Cell and Gene Therapy, Texas Children's Hospital, Houston Methodist Hospital and Baylor College of Medicine, 1102 Bates Ave, Suite 1770, Houston, TX, 77030, USA
| | - Rayne H Rouce
- Center for Cell and Gene Therapy, Texas Children's Hospital, Houston Methodist Hospital and Baylor College of Medicine, 1102 Bates Ave, Suite 1770, Houston, TX, 77030, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Cliona M Rooney
- Center for Cell and Gene Therapy, Texas Children's Hospital, Houston Methodist Hospital and Baylor College of Medicine, 1102 Bates Ave, Suite 1770, Houston, TX, 77030, USA. .,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA. .,Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA. .,Department of Molecular Virology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA.
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Ozay EI, Vijayaraghavan J, Gonzalez-Perez G, Shanthalingam S, Sherman HL, Garrigan DT, Chandiran K, Torres JA, Osborne BA, Tew GN, Slukvin II, Macdonald RA, Kelly K, Minter LM. Cymerus™ iPSC-MSCs significantly prolong survival in a pre-clinical, humanized mouse model of Graft-vs-host disease. Stem Cell Res 2019; 35:101401. [PMID: 30738321 PMCID: PMC6544140 DOI: 10.1016/j.scr.2019.101401] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/25/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022] Open
Abstract
The immune-mediated tissue destruction of graft-vs-host disease (GvHD) remains a major barrier to greater use of hematopoietic stem cell transplantation (HSCT). Mesenchymal stem cells (MSCs) have intrinsic immunosuppressive qualities and are being actively investigated as a therapeutic strategy for treating GvHD. We characterized Cymerus™ MSCs, which are derived from adult, induced pluripotent stem cells (iPSCs), and show they display surface markers and tri-lineage differentiation consistent with MSCs isolated from bone marrow (BM). Administering iPSC-MSCs altered phosphorylation and cellular localization of the T cell-specific kinase, Protein Kinase C theta (PKCθ), attenuated disease severity, and prolonged survival in a humanized mouse model of GvHD. Finally, we evaluated a constellation of pro-inflammatory molecules on circulating PBMCs that correlated closely with disease progression and which may serve as biomarkers to monitor therapeutic response. Altogether, our data suggest Cymerus iPSC-MSCs offer the potential for an off-the-shelf, cell-based therapy to treat GvHD.
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Affiliation(s)
- E Ilker Ozay
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Polymer Science & Engineering, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Jyothi Vijayaraghavan
- Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Gabriela Gonzalez-Perez
- Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Sudarvili Shanthalingam
- Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Heather L Sherman
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Daniel T Garrigan
- Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Karthik Chandiran
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Joe A Torres
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Barbara A Osborne
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Gregory N Tew
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
| | - Igor I Slukvin
- Cynata Therapeutics Limited, Carlton, Victoria 3053, Australia; Department of Polymer Science & Engineering, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Ross A Macdonald
- Department of Polymer Science & Engineering, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Kilian Kelly
- Department of Polymer Science & Engineering, University of Massachusetts Amherst, Amherst, MA 01003, United States
| | - Lisa M Minter
- Graduate Program in Molecular and Cellular Biology, University of Massachusetts Amherst, Amherst, MA 01003, United States; Department of Veterinary & Animal Sciences, University of Massachusetts Amherst, Amherst, MA 01003, United States.
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Abstract
Background Membranous nephropathy (MN), the leading cause of nephrotic syndrome in adults, is characterized by the deposition of subepithelial immune deposits. Most of the cases are primary, while only approximately 25% of the cases are secondary to some known diseases. Recently, MN has been considered to be a possible presentation of chronic graft-versus-host disease (GVHD) of the kidney in allogeneic hematopoietic stem cell transplantation (HSCT) patients. In autologous HSCT populations, there have been scarce reports of associated MN, as a result of immune dysregulation leading to systemic autoimmunity and miming chronic GVHD. Case presentation We report an exceptional case of MN associated to an acute renal failure occurring within days following an autologous HSCT indicated by multiple myeloma. There was no evidence of GVHD or myeloma relapse. A complete remission of nephrotic syndrome with normalization of renal function were rapidly obtained by corticosteroid therapy. Conclusion This is the first published case of acute renal failure due to MN occurring in the acute phase of an autologous HSCT. These findings support the antibodymediated autoimmune glomerular disease.
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Affiliation(s)
- Sanda Mrabet
- Department of Nephrology, Dialysis and transplantation. Sahloul university Hospital, Sousse, Tunisia.
| | - Narjess Ben Aicha
- Department of Nephrology, Dialysis and transplantation. Sahloul university Hospital, Sousse, Tunisia
| | - Nihed Abdessayed
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Moncef Mokni
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Abdellatif Achour
- Department of Nephrology, Dialysis and transplantation. Sahloul university Hospital, Sousse, Tunisia
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Abstract
OBJECTIVES Graft-vs-host disease (GVHD) is a donor T-cell-mediated disorder affecting the recipient's skin, gastrointestinal tract, lungs, and liver. It complicates up to 70% of hematopoietic cell transplantation and is associated with high morbidity and mortality rates. METHODS An extensive review of the literature has been performed to include the most current consensus on the histopathologic diagnosis of gastrointestinal and liver GVHD. RESULTS In this review, we present an overview of GVHD, with emphasis on the histopathologic evaluation of gastrointestinal and liver specimens, including the most important differential diagnoses and possible pitfalls. CONCLUSIONS Histopathologic examination remains the mainstay of diagnosis of gastrointestinal and liver GVHD and is interpreted in conjunction with clinical and laboratory data.
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Affiliation(s)
- Marcela Salomao
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY;
| | - Kathleen Dorritie
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and the University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Markus Y Mapara
- Department of Medicine, Division of Hematology/Oncology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Antonia Sepulveda
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
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11
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Pérol L, Martin GH, Maury S, Cohen JL, Piaggio E. Potential limitations of IL-2 administration for the treatment of experimental acute graft-versus-host disease. Immunol Lett 2014; 162:173-84. [PMID: 25445496 DOI: 10.1016/j.imlet.2014.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 12/28/2022]
Abstract
Low-dose IL-2 administration can control autoimmunity by specifically activating CD4(+) Foxp3(+) regulatory T cells (Tregs). Here, we studied IL-2-based immunotherapy in experimental graft-versus-host disease (GVHD). IL-2 administration to donor mice induced a dose-dependent expansion of Tregs in the graft but was insufficient to control GVHD. IL-2 administration to allogeneic-grafted recipient mice activated T-conventional cells (Tcons) and did not prevent GVHD. This loss of IL-2 selectivity toward Tregs was explained by an IL-2-induced increase in the IL-2 receptor α-chain expression on Tcons. Finally, in xeno-GVHD generated by human PBMCs transplanted into immunodeficient mice, low-dose IL-2 increased Treg frequencies but did neither control pro-inflammatory cytokine production by pathogenic Tcons, nor prevented GVHD. Furthermore, combination of low-dose IL-2 with rapamycin was ineffective in this model. Our results indicate that limitations on the use of IL-2 during acute GVHD are likely due to the massive activation of the allogeneic T cells unique to this setting.
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Jung YJ, Jeon YJ, Cho WK, Lee JW, Chung NG, Jung MH, Cho B, Suh BK. Risk factors for short term thyroid dysfunction after hematopoietic stem cell transplantation in children. Korean J Pediatr 2013; 56:298-303. [PMID: 23908670 PMCID: PMC3728449 DOI: 10.3345/kjp.2013.56.7.298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/12/2012] [Accepted: 10/23/2012] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to evaluate short-term thyroid dysfunction and related risk factors in pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) during childhood. Methods We studied 166 patients (100 boys and 66 girls) who underwent HSCT at the Catholic HSCT Center from January 2004 through December 2009. The mean age at HSCT was 10.0±4.8 years. Thyroid function of the patients was tested before and during 3 months of HSCT. Results Out of 166 patients, 165 (99.4%) underwent allotransplantation. Acute graft-versus-host disease (GVHD, grades II to IV) developed in 76 patients. Conditioning regimens before HSCT include total body irradiation (n=57), busulfan (n=80), and reduced intensity (n=29). Forty-five (27.1%) had thyroid dysfunction during 3 months after HSCT (29 euthyroid sick syndrome [ESS], 6 subclinical hyperthyroidism, 4 subclinical hypothyroidism, 3 hypothyroxinemia, 2 overt hyperthyroidism, and 1 high T4 syndrome). In a univariate logistic regression analysis, age at HSCT (P=0.002) and acute GVHD (P=0.009) had statistically significant relationships with thyroid dysfunction during 3 months after HSCT. Also, in a univariate logistic regression analysis, ESS (P=0.014) showed a strong statistically significant association with mortality. Conclusion In our study 27.1% patients experienced thyroid dysfunction during 3 months after HSCT. Increase in age and acute GVHD may be risk factors for thyroid dysfunction during 3 months after HSCT. There was a significant association between ESS and mortality.
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Affiliation(s)
- You Jin Jung
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
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Chen XB, Yang J, Xu MQ, Wen TF, Yan LN. Unsuccessful treatment of four patients with acute graft- vs-host disease after liver transplantation. World J Gastroenterol 2012; 18:84-9. [PMID: 22228975 PMCID: PMC3251810 DOI: 10.3748/wjg.v18.i1.84] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/23/2011] [Accepted: 06/30/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate appropriate therapeutic strategies for graft-vs-host disease (GVHD) following liver transplantation.
METHODS: Four patients who developed GVHD after liver transplantation in West China Hospital were included in this study. Therapeutic strategies with augmentation or withdrawal of immunosuppressants combined with supportive therapy were investigated in these patients. In addition, a literature review of patients who developed GVHD after liver transplantation was performed.
RESULTS: Although a transient response to initial treatment was detected, all four patients died of complications from GVHD: one from sepsis with multiple organ failure, one from gastrointestinal bleeding, and the other two from sepsis with gastrointestinal bleeding. Few consensuses for the treatment of GVHD after liver transplantation have been reached.
CONCLUSION: New and effective treatments are required for GVHD after liver transplantation to improve the prognosis of patients with this diagnosis.
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