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Blood, 15 November 2007, Vol. 110, No. 10, pp. 3804-3813.
Prepublished online as a Blood First Edition Paper on August 10, 2007; DOI 10.1182/blood-2007-05-091074.
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Submitted May 18, 2007
Accepted August 7, 2007
Absence of regulatory T cell control of TH1 and TH17 cells is responsible for the autoimmune-mediated pathology in chronic graft versus host disease
Xiao Chen, Sanja Vodanovic-Jankovic, Bryon Johnson, Melissa Keller, Richard Komorowski, and William R Drobyski*
Bone Marrow Transplant Program, Medical College of Wisconsin, Milwaukee, WI, United States
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
* Corresponding author; email: wdrobysk{at}mcw.edu.
Graft versus host disease (GVHD) remains the major complication after allogeneic bone marrow transplantation (BMT). The process whereby acute GVHD mediated by alloreactive donor T cells transitions into chronic GVHD which is characterized by prominent features of autoimmunity has long been unresolved. In this study, we demonstrate that GVHD-associated autoimmunity and, by extension, chronic GVHD is attributable to the progressive loss of CD4+CD25+Foxp3+ regulatory T cells during the course of acute GVHD. This leads to the expansion of donor-derived CD4+ T cells with TH1 and TH17 cytokine phenotypes that release proinflammatory cytokines and cause autoimmune-mediated pathological damage. These T cells are present early post transplantation indicating that the pathophysiological events that lead to chronic GVHD are set in motion during the acute phase of GVHD. We conclude that the absence of CD4+CD25+ regulatory T cells coupled with unregulated TH1 and TH17 cells leads to the development of autoimmunity and that donor-derived TH1 and TH17 cells serve as the nexus between acute and chronic GVHD.

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