The primacy of the gastrointestinal tract as a target organ of acute graft-versus-host disease: rationale for the use of cytokine shields in allogeneic bone marrow …

GR Hill, JLM Ferrara - Blood, The Journal of the American …, 2000 - ashpublications.org
GR Hill, JLM Ferrara
Blood, The Journal of the American Society of Hematology, 2000ashpublications.org
Acute graft-versus-host disease (GVHD), the major complication of allogeneic bone marrow
transplantation (BMT), limits the application of this curative but toxic therapy. Studies of
inflammatory pathways involved in GVHD in animals have shown that the gastrointestinal
(GI) tract plays a major role in the amplification of systemic disease. Damage to the GI tract
increases the translocation of inflammatory stimuli such as endotoxin, which promotes
further inflammation and additional GI tract damage. The GI tract is therefore critical to the …
Acute graft-versus-host disease (GVHD), the major complication of allogeneic bone marrow transplantation (BMT), limits the application of this curative but toxic therapy. Studies of inflammatory pathways involved in GVHD in animals have shown that the gastrointestinal (GI) tract plays a major role in the amplification of systemic disease. Damage to the GI tract increases the translocation of inflammatory stimuli such as endotoxin, which promotes further inflammation and additional GI tract damage. The GI tract is therefore critical to the propagation of the “cytokine storm” characteristic of acute GVHD. Experimental approaches to the prevention of GVHD include reducing the damage to the GI tract by fortification of the GI mucosal barrier through novel “cytokine shields” such as IL-11 or keratinocyte growth factor. Such strategies have reduced GVHD while preserving a graft-versus-leukemia effect in animal models, and they now deserve formal testing in carefully designed clinical trials.
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