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Blood, 1 August 2001, Vol. 98, No. 3, pp. 868-876
TRANSPLANTATION
Characterization of the T-cell repertoire in autologous
graft-versus-host disease (GVHD): evidence for the involvement of
antigen-driven T-cell response in the development of
autologous GVHD
Yuji Miura,
Christopher J. Thoburn,
Emilie C. Bright,
Matthias Sommer,
Susan Lefell,
Mikio Ueda,
Shinji Nakao, and
Allan D. Hess
From the Oncology Center, Johns Hopkins University
School of Medicine, Baltimore, MD; the Department of Hematology and
Immunology, Ishikawa Prefectural Central Hospital; and the Third
Department of Medicine, Kanazawa University School of Medicine, Japan.
Administration of cyclosporine A (CsA) after autologous stem cell
transplantation elicits an autoimmune syndrome with pathology similar
to graft-versus-host disease (GVHD). This syndrome, termed autologous
GVHD, is associated with the appearance of autoreactive T cells
directed at major histocompatibility class (MHC) class II antigens. In
the rat model of autologous GVHD, clonal analysis reveals that the
effector T cells are highly conserved and recognize a peptide from the
invariant chain peptide presented by MHC class II. Although human
autologous GVHD effector T cells share a similar phenotypic
specificity, clonality of the response in humans has not been
determined. To examine the human effector T-cell response, the T-cell
repertoire of peripheral blood lymphocytes was assessed by
complementarity-determining region 3 (CDR3) size distribution analysis
and T-cell clonotype analysis in 26 patients treated with CsA after
transplantation. Autologous GVHD developed in 3 of 4 patients with
human leukocyte antigen (HLA)-DRB1*0701, and clonal expansions of
-chain variable region (BV)16+ T cells were shared.
Clonal expansions within BV15+ and BV22+ T
cells were also detected in 4 of 6 patients with HLA-DRB1*1501 and in 3 of 4 patients with HLA-DRB1*0401, respectively. Sequencing of BV16 cDNA
for which the CDR3 size pattern exhibited apparent clone predominance
revealed an identical CDR3 peptide sequence in 2 different patients,
one with HLA-DRB1*0701 and the other with HLA-DRB1*1502. These findings
indicate that the discrete antigen-driven expansion of T cells is
involved in autologous GVHD.

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