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Blood, 15 June 2005, Vol. 105, No. 12, pp. 4885-4891.
Prepublished online as a Blood First Edition Paper on March 3, 2005; DOI 10.1182/blood-2004-12-4980.
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Submitted January 3, 2005
Accepted February 10, 2005
Emergent autoimmunity in graft versus host disease
Elizabeth Tivol, Richard Komorowski, and William R Drobyski*
Bone Marrow Transplant Program and the Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
Department of Pathology, Medical College of Wisconsin, Milwuakee, WI, USA
* Corresponding author; email: bill{at}bmt.mcw.edu.
Donor T cell recognition of host alloantigens presented by host antigen presenting cells (APCs) is necessary for the induction of GVHD, but whether direct alloreactivity is sufficient for the propagation of GVHD is unknown. In this study, we demonstrate that GVHD cannot be effectively propagated through the direct pathway of allorecognition. Rather, donor T cell recognition of antigens through the indirect pathway is necessary for the perpetuation of GVHD. Furthermore, GVHD results in the breaking of self tolerance resulting in the emergence of donor T cells that can cause autoimmune disease in syngeneic recipients. Notably, GVHD-induced autoreactivity is donor APC-dependent, transferable into secondary hosts, and involves cells of the innate immune system. These results indicate that donor T cell-mediated pathological damage during GVHD becomes donor APC-dependent, and provide a mechanistic explanation for the longstanding observation that GVHD is associated with autoimmune clinical manifestations.

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