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Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency?
Allogeneic hematopoietic stem cell transplant (HSCT) is used to treat increasing numbers of malignant and non-malignant disorders. Despite significant advances in improved human leukocyte antigens-typing techniques, less toxic conditioning regimens and better supportive care, resulting in improved c...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359217/ https://www.ncbi.nlm.nih.gov/pubmed/28377772 http://dx.doi.org/10.3389/fimmu.2017.00328 |
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author | Flinn, Aisling M. Gennery, Andrew R. |
author_facet | Flinn, Aisling M. Gennery, Andrew R. |
author_sort | Flinn, Aisling M. |
collection | PubMed |
description | Allogeneic hematopoietic stem cell transplant (HSCT) is used to treat increasing numbers of malignant and non-malignant disorders. Despite significant advances in improved human leukocyte antigens-typing techniques, less toxic conditioning regimens and better supportive care, resulting in improved clinical outcomes, acute graft-versus-host disease (aGvHD) continues to be a major obstacle and, although it principally involves the skin, gastrointestinal tract, and liver, the thymus is also a primary target. An important aim following HSCT is to achieve complete and durable immunoreconstitution with a diverse T-cell receptor (TCR) repertoire to recognize a broad range of pathogens providing adequate long-term adaptive T-lymphocyte immunity, essential to reduce the risk of infection, disease relapse, and secondary malignancies. Reconstitution of adaptive T-lymphocyte immunity is a lengthy and complex process which requires a functioning and structurally intact thymus responsible for the production of new naïve T-lymphocytes with a broad TCR repertoire. Damage to the thymic microenvironment, secondary to aGvHD and the effect of corticosteroid treatment, disturbs normal signaling required for thymocyte development, resulting in impaired T-lymphopoiesis and reduced thymic export. Primary immunodeficiencies, in which failure of central or peripheral tolerance is a major feature, because of intrinsic defects in hematopoietic stem cells leading to abnormal T-lymphocyte development, or defects in thymic stroma, can give insights into critical processes important for recovery from aGvHD. Extracorporeal photopheresis is a potential alternative therapy for aGvHD, which acts in an immunomodulatory fashion, through the generation of regulatory T-lymphocytes (Tregs), alteration of cytokine patterns and modulation of dendritic cells. Promoting normal central and peripheral immune tolerance, with selective downregulation of immune stimulation, could reduce aGvHD, and enable a reduction in other immunosuppression, facilitating thymic recovery, restoration of normal T-lymphocyte ontogeny, and complete immunoreconstitution with improved clinical outcome as the ability to fight infections improves and risk of secondary malignancy or relapse diminishes. |
format | Online Article Text |
id | pubmed-5359217 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-53592172017-04-04 Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? Flinn, Aisling M. Gennery, Andrew R. Front Immunol Immunology Allogeneic hematopoietic stem cell transplant (HSCT) is used to treat increasing numbers of malignant and non-malignant disorders. Despite significant advances in improved human leukocyte antigens-typing techniques, less toxic conditioning regimens and better supportive care, resulting in improved clinical outcomes, acute graft-versus-host disease (aGvHD) continues to be a major obstacle and, although it principally involves the skin, gastrointestinal tract, and liver, the thymus is also a primary target. An important aim following HSCT is to achieve complete and durable immunoreconstitution with a diverse T-cell receptor (TCR) repertoire to recognize a broad range of pathogens providing adequate long-term adaptive T-lymphocyte immunity, essential to reduce the risk of infection, disease relapse, and secondary malignancies. Reconstitution of adaptive T-lymphocyte immunity is a lengthy and complex process which requires a functioning and structurally intact thymus responsible for the production of new naïve T-lymphocytes with a broad TCR repertoire. Damage to the thymic microenvironment, secondary to aGvHD and the effect of corticosteroid treatment, disturbs normal signaling required for thymocyte development, resulting in impaired T-lymphopoiesis and reduced thymic export. Primary immunodeficiencies, in which failure of central or peripheral tolerance is a major feature, because of intrinsic defects in hematopoietic stem cells leading to abnormal T-lymphocyte development, or defects in thymic stroma, can give insights into critical processes important for recovery from aGvHD. Extracorporeal photopheresis is a potential alternative therapy for aGvHD, which acts in an immunomodulatory fashion, through the generation of regulatory T-lymphocytes (Tregs), alteration of cytokine patterns and modulation of dendritic cells. Promoting normal central and peripheral immune tolerance, with selective downregulation of immune stimulation, could reduce aGvHD, and enable a reduction in other immunosuppression, facilitating thymic recovery, restoration of normal T-lymphocyte ontogeny, and complete immunoreconstitution with improved clinical outcome as the ability to fight infections improves and risk of secondary malignancy or relapse diminishes. Frontiers Media S.A. 2017-03-21 /pmc/articles/PMC5359217/ /pubmed/28377772 http://dx.doi.org/10.3389/fimmu.2017.00328 Text en Copyright © 2017 Flinn and Gennery. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Flinn, Aisling M. Gennery, Andrew R. Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title | Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title_full | Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title_fullStr | Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title_full_unstemmed | Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title_short | Treatment of Pediatric Acute Graft-versus-Host Disease—Lessons from Primary Immunodeficiency? |
title_sort | treatment of pediatric acute graft-versus-host disease—lessons from primary immunodeficiency? |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359217/ https://www.ncbi.nlm.nih.gov/pubmed/28377772 http://dx.doi.org/10.3389/fimmu.2017.00328 |
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