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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1717-1723.
Prepublished online as a Blood First Edition Paper on November 8, 2005; DOI 10.1182/blood-2005-06-2529.
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Submitted June 27, 2005
Accepted October 9, 2005
Mucosal FOXP3+ regulatory T cells are numerically deficient in acute and chronic GvHD
Kathrin Rieger*, Christoph Loddenkemper, Jochen Maul, Thomas Fietz, Daniel Wolff, Harald Terpe, Beate Steiner, Erika Berg, Stephan Miehlke, Martin Bornhauser, Thomas Schneider, Martin Zeitz, Harald Stein, Eckhard Thiel, Rainer Duchmann, and Lutz Uharek
Medical Clinic III, Hematology, Oncology and Transfusion Medicine, Charite- University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Consultation and Reference Center for Lymph Node Pathology and Hematopathology- Institute for Pathology, Charite- University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Medical Clinic II, Gastroenterology, Charite- University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Devision of Hematology and Oncology, University of Rostock, Rostock, Germany
Department of Pathology, University of Rostock, Rostock, Germany
Department of Gastroenterology, University School of Medicine Dresden, Dresden, Germany
Department of Hematology, University School of Medicine Dresden, Dresden, Germany
* Corresponding author; email: kathrin.rieger{at}charite.de.
CD4+CD25+ regulatory T cells (Treg) control immune responses to self- and foreign antigens and play a pivotal role in autoimmune diseases, infectious and non-infectious inflammation and graft rejection. Since recent experimental studies have indicated that Treg were able to ameliorate graft-versus-host-disease (GvHD), we analysed the number of infiltrating Treg in the intestinal mucosa, as one site of GvH-reactivity using immunoenzymatic labeling to enumerate FOXP3+ T cells in 95 intestinal biopsies from 49 allografted patients in comparison to healthy controls and patients with infectious inflammation.
While patients with CMV-colitis or diverticulitis showed a concomitant increase of CD8+ effectors and Treg, acute and chronic GvHD were characterized by the complete lack of a counterregulation indicated by a FOXP3+/ CD8+ T cell ratio identical to healthy controls. In contrast, specimens without histological signs of GvHD demonstrated increased numbers of FOXP3+ per CD8+ T cells indicating that the potential for Treg expansion is principally maintained in allografted patients. Our findings provide evidence that GvHD is associated with an insufficient upregulation of Treg in intestinal GvHD lesions. The determination of FOXP3+/ CD8+ ratio can be a helpful tool to discriminate GvHD from infectious inflammation after allogeneic stem cell transplantation.

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