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Blood, 15 December 2007, Vol. 110, No. 13, pp. 4588-4598.
Prepublished online as a Blood First Edition Paper on September 7, 2007; DOI 10.1182/blood-2007-08-106005.
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Submitted August 10, 2007
Accepted September 4, 2007
Preemptive HMG-CoA reductase inhibition provides graft-versus-host disease protection by Th-2 polarization while sparing graft-versus-leukemia activity
Robert Zeiser, Sawsan Youssef, Jeanette Baker, Neeraja Kambham, Lawrence Steinman, and Robert S Negrin*
Division of Hematology and Oncology, Department of Medicine, Albert Ludwig University Freiburg, Freiburg, Germany
Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
Division of Bone Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
* Corresponding author; email: negrs{at}stanford.edu.
We investigated whether atorvastatin (AT) was capable of protecting animals from acute graft-versus-host disease (aGvHD) across major-MHC mismatch barriers. AT treatment of the donor induced a Th-2 cytokine profile in the adoptively transferred T cells and reduced their in vivo expansion, which translated into significantly reduced aGvHD lethality. Host treatment down-regulated costimulatory molecules and MHC class II expression on recipient APCs and enhanced the protective statin effect, without impacting Graft-versus-leukemia (GvL) activity. The AT effect was partially reversed in STAT6-/- donors and abrogated by L-mevalonate, indicating the relevance of STAT6 signaling and the L-mevalonate pathway for AT mediated aGvHD protection. AT reduced prenylation levels of GTPases, abolished T-bet expression and increased c-MAF and GATA-3 protein in vivo. Thus, AT has significant protective impact on aGvHD lethality by Th-2 polarization and inhibition of an uncontrolled Th-1 response while maintaining GvL activity, which is of great clinical relevance given the modest toxicity profile of AT.

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