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Blood, 5 February 2009, Vol. 113, No. 6, pp. 1365-1374.
Prepublished online as a Blood First Edition Paper on October 28, 2008; DOI 10.1182/blood-2008-06-162420.
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Submitted June 12, 2008
Accepted October 21, 2008
In vitro differentiated TH17 cells mediate lethal acute graft-versus-host disease with severe cutaneous and pulmonary pathology
Michael J Carlson, Michelle L West, James M Coghill, Angela Panoskaltsis-Mortari, Bruce R Blazar, and Jonathan S Serody*
Departments of Medicine, Microbiology, and Immunology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota Cancer Center, Minneapolis, MN, United States
* Corresponding author; email: jonathan_serody{at}med.unc.edu.
The morbidity and mortality associated with graft-host-disease (GVHD) is a significant obstacle to the greater use of allogeneic stem cell transplantation. Donor T cells that predominantly differentiate into TH1/Tc1 T cells and generate pro-inflammatory cytokines such as IFN- mediate GVHD. Although numerous studies have described a pathogenic role for IFN- , multiple reports have demonstrated that the lack of IFN- paradoxically exacerbated GVHD lethality. This has led to speculation that another subset of T cells may significantly contribute to GVHD mortality. Recently, several groups have demonstrated a new lineage of CD4+ T helper cell development distinct from TH1 or TH2 differentiation. This lineage is characterized by production of IL-17A, IL-17F, IL-22, and IL-21 and have been termed TH17 cells. Here, we demonstrate that a highly purified population of TH17 cells is capable of inducing lethal GVHD, hallmarked by extensive cutaneous and pulmonary pathology. Upon transfer these cells migrate to and expand in GVHD target organs and secondary lymphoid tissues. Lastly, we demonstrate differential roles for TNF- and IL-17A in the clinical manifestations of GVHD induced by TH17 cells. Our studies demonstrate that cells other than TH1/Tc1 can mediate acute GVHD.

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