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Blood, 15 April 2002, Vol. 99, No. 8, pp. 3033-3040
TRANSPLANTATION
Activated eosinophils in upper gastrointestinal tract of
patients with graft-versus-host disease
Marjan Daneshpouy,
Gerard Socie,
Marc Lemann,
Jacqueline Rivet,
Eliane Gluckman, and
Anne Janin
From the Laboratoire de Recherche Universitaire
de Pathologie UPRES EA 2378, Institut Universitaire
d'Hématologie, the Service d'Hématologie, Greffes de
Moelle Osseuse, and the Service d'Hépatogastroentérologie,
Hôpital Saint-Louis, Paris, France.
Digestive tract damage during graft-versus-host reaction (GVHR)
causes high morbidity and mortality. Diagnosis is often late because
biopsies are performed when clinical signs are severe and pathologic
markers of early inflammatory lesions are lacking. Eosinophils are
inflammatory cells, cytotoxic in vitro to digestive epithelium; they
are found in biopsy specimens taken during acute flare-ups of
inflammatory bowel disease. We performed systematic duodenal biopsies
immediately after digestive symptoms occurred and found a digestive
GVHR incidence of 73.1% (n = 93), higher than that found when
digestive biopsies were performed immediately after severe clinical
signs. Eosinophils were only present when there were histologic signs
of GVHR; eosinophil presence correlated with GVHR severity. Electron
microscopy with immunogold staining showed pathologic signs of in situ
eosinophil activation, such as cytoplasmic granule alterations, and
eosinophil peroxidase release in all patients. Interleukin-5 presence
in activated eosinophils suggests eosinophil recruitment in digestive
GVHR is an autocrine mechanism. Eosinophil density also correlated with
GVHR severity, whether in acute or chronic clinical phases. Tissue
eosinophils could thus be a marker of acute inflammatory flare-ups in
GVHR. Systematic duodenal biopsy performed at the onset of digestive symptoms should allow early GVHR detection, and pathologic signs of
GVHR, together with eosinophil density, might help modulate immunosuppressive therapy.
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