Interaktion von B-Zellen und Dendritischen Zellen am Beispiel der chronischen Graft-versus-Host Disease / B cells and DCs are suspected to play an important role in the pathogenesis of cGvHD, which is a serious complication of HSCT with high morbidity. It is characterized by immune responses of donor immune cells against recipient-derived antigens. Pathogenesis is not yet fully understood, however reconstitution of B cells after HSCT has similarities to physiologic ontogeny. Immunophenotyping and co-cultivation-experiments of B cells and DCs from pediatric patients with cGvHD as well as healthy donors were conducted. Significant differences between patients and healthy donors were observed with increased memory, transitional, CD69+ and CD86+ phenotype and lower levels of naïve B cells due to apoptosis. Co-cultivation revealed this to be primarily B cell-dependent without major effects of and with DCs. There was a decreased CD11c- phenotype in patients and less apoptosis of DCs. Our data suggest a disturbed homeostasis in B cells with increased memory phenotype in patients, whereas DCs could not influence these differences, therefore DCs are not imposing as promising targets. B cell-dependent approaches should be further investigated.

A infecção por citomegalovírus (CMV) tem efeito duradouro na distribuição dos subtipos de células T, mas pouco se sabe sobre o seu impacto na função celular. Foi realizada uma análise de expressão global gênica em células CD4+ purificadas em 38 recipientes de transplante de células tronco hematopoéticas (HSCT) (mediana de idade 48 anos; variação 20-65 anos) estudados em média cinco anos pós transplante (mediana 4.75 anos; variação 1-20 years). A população estudada incluiu 18 pacientes com GVHD crônico ativo (cGVHD) e 20 pacientes considerados tolerantes. Tolerância foi definida como ausência de sinais e sintomas de cGVHD, assim como ausência de tratamento imunossupressor (IST) por pelo menos 2 meses com seguimento de 1 ano sem tratamento imunossupressor. A expressão gênica foi medida por Illumina bead arrays. O seroestato do CMV foi definido pela sorologia pré transplante (por ELISA). Não havia evidência documentada de reativação do CMV no momento de coleta das amostras estudadas. Doze de 54 genes candidatos associados à função imune foram associados de maneira significativa com CMV+ em pacientes com cGVHD ativo (p<0.05) (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), sendo que somente três genes (CD14; CD86; IER3) foram associados a CMV+ entre os pacientes tolerantes. A expressão de PD-1 significativamente maior em pacientes CMV+ e com cGVHD ativo foi confirmada em uma população independente através de estudos de imunofenotipagem. Os pacientes CMV+/cGVHD ativos tiveram um perfil compatível com ativação de células T efetoras, não sendo detectado com a mesma intensidade em pacientes tolerantes e pacientes CMV-/cGVHD ativos. Tendo como objetivo a latência da infecção, o citomegalovírus tentará evadir-se das tentativas do sistema imune de depuração viral, criando modificações que vão desde mudanças nos subtipos de linfócitos até a remodelação de cromatina por uma série de enzimas e microRNA. O ambiente caracteristicamente inflamatório do cGVHD, a produção aumentada de citocinas, a terapia imunossupressora e a reconstituição imune defeituosa das células T podem aumentar o risco de reativação do CMV, mesmo indetectável, seguido por supra-regulação de genes relacionados à ativação de células T e função efetora. O gene PD-1 pode estar supra-regulado em ativação de células T e função efetora, mas tem papel essencial na prevenção da expansão e função das células T efetoras, sendo um candidato alvo para a prevenção e tratamento do cGVHD. Entender o impacto do CMV na regulação de PD-1 em pacientes com cGVHD seria instrumental na implementação de novas terapias; portanto mais estudos com populações maiores são necessários para entendermos o impacto da imunomodulação secundária à infecção prévia por CMV no funcionamento das células T durante cGVHD. / Cytomegalovirus infection (CMV) is known to have a life-long effect on the distribution of T cell subsets, but little is known about the impact on cell function. We performed a gene expression analysis in purified CD4+ T cells from 38 hematopoietic cell transplant (HCT) recipients (median age 48; range 20-65) studied on average 5 years after HCT (median 4.75; range 1-20 years). The study population included 18 patients with active chronic GVHD (cGVHD) and 20 tolerant (TOL) patients. Tolerance was defined by absence of signs, symptoms of cGVHD and immunosuppressive therapy (IST) for at least 2 months and 1 year follow-up without immunosupressive therapy . Gene expression was measured on Illumina bead arrays. CMV status was defined by pre-transplant recipient CMV serology (by ELISA). There was no recorded evidence of CMV reactivation at the time of study. Twelve of 54 candidate genes associated with immune function and inflammation were found to be associated CMV positive serostatus in cGVHD patients at a significance threshold of p<0.05 (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), but only three genes (CD14; CD86; IER3) were associated with CMV serostatus in TOL patients. The significant higher PD-1 expression on CD4+ cells of CMV+/active cGVHD patients was confirmed by immunophenotype testing in an independent population. CMV+/active cGVHD patients had a profile consistent with T effector cell activation that was not present in TOL and CMV serostatus negative/active cGVHD patients. Pursuing latency, cytomegalovirus will try to evade the immune system attempts of viral clearance creating modifications varying from changes in lymphocyte subsets to chromatin remodeling by several enzymes and microRNA. The chronic GVHD characteristic inflammatory environment, increased cytokine production, immunosuppressive therapy, and impaired T cell immune reconstitution, may increase the risk of CMV reactivation, even if not detectable, followed by up-regulation of genes related to T cell activation and effector function. The PD-1 gene can be up-regulated in T cell activation and effector functions, but it also has an essential role in preventing the expansion and function of effector cells, being a candidate target for the prevention or treatment of chronic GVHD. Understanding the CMV impact on the PD-1 regulation in active cGVHD would be key on the implementation of new therapies.Thus, more studies in larger populations are needed in order to understand CMV previous infection immunomodulation impact in T cell function during chronic GVHD.

A infecção por citomegalovírus (CMV) tem efeito duradouro na distribuição dos subtipos de células T, mas pouco se sabe sobre o seu impacto na função celular. Foi realizada uma análise de expressão global gênica em células CD4+ purificadas em 38 recipientes de transplante de células tronco hematopoéticas (HSCT) (mediana de idade 48 anos; variação 20-65 anos) estudados em média cinco anos pós transplante (mediana 4.75 anos; variação 1-20 years). A população estudada incluiu 18 pacientes com GVHD crônico ativo (cGVHD) e 20 pacientes considerados tolerantes. Tolerância foi definida como ausência de sinais e sintomas de cGVHD, assim como ausência de tratamento imunossupressor (IST) por pelo menos 2 meses com seguimento de 1 ano sem tratamento imunossupressor. A expressão gênica foi medida por Illumina bead arrays. O seroestato do CMV foi definido pela sorologia pré transplante (por ELISA). Não havia evidência documentada de reativação do CMV no momento de coleta das amostras estudadas. Doze de 54 genes candidatos associados à função imune foram associados de maneira significativa com CMV+ em pacientes com cGVHD ativo (p<0.05) (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), sendo que somente três genes (CD14; CD86; IER3) foram associados a CMV+ entre os pacientes tolerantes. A expressão de PD-1 significativamente maior em pacientes CMV+ e com cGVHD ativo foi confirmada em uma população independente através de estudos de imunofenotipagem. Os pacientes CMV+/cGVHD ativos tiveram um perfil compatível com ativação de células T efetoras, não sendo detectado com a mesma intensidade em pacientes tolerantes e pacientes CMV-/cGVHD ativos. Tendo como objetivo a latência da infecção, o citomegalovírus tentará evadir-se das tentativas do sistema imune de depuração viral, criando modificações que vão desde mudanças nos subtipos de linfócitos até a remodelação de cromatina por uma série de enzimas e microRNA. O ambiente caracteristicamente inflamatório do cGVHD, a produção aumentada de citocinas, a terapia imunossupressora e a reconstituição imune defeituosa das células T podem aumentar o risco de reativação do CMV, mesmo indetectável, seguido por supra-regulação de genes relacionados à ativação de células T e função efetora. O gene PD-1 pode estar supra-regulado em ativação de células T e função efetora, mas tem papel essencial na prevenção da expansão e função das células T efetoras, sendo um candidato alvo para a prevenção e tratamento do cGVHD. Entender o impacto do CMV na regulação de PD-1 em pacientes com cGVHD seria instrumental na implementação de novas terapias; portanto mais estudos com populações maiores são necessários para entendermos o impacto da imunomodulação secundária à infecção prévia por CMV no funcionamento das células T durante cGVHD. / Cytomegalovirus infection (CMV) is known to have a life-long effect on the distribution of T cell subsets, but little is known about the impact on cell function. We performed a gene expression analysis in purified CD4+ T cells from 38 hematopoietic cell transplant (HCT) recipients (median age 48; range 20-65) studied on average 5 years after HCT (median 4.75; range 1-20 years). The study population included 18 patients with active chronic GVHD (cGVHD) and 20 tolerant (TOL) patients. Tolerance was defined by absence of signs, symptoms of cGVHD and immunosuppressive therapy (IST) for at least 2 months and 1 year follow-up without immunosupressive therapy . Gene expression was measured on Illumina bead arrays. CMV status was defined by pre-transplant recipient CMV serology (by ELISA). There was no recorded evidence of CMV reactivation at the time of study. Twelve of 54 candidate genes associated with immune function and inflammation were found to be associated CMV positive serostatus in cGVHD patients at a significance threshold of p<0.05 (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), but only three genes (CD14; CD86; IER3) were associated with CMV serostatus in TOL patients. The significant higher PD-1 expression on CD4+ cells of CMV+/active cGVHD patients was confirmed by immunophenotype testing in an independent population. CMV+/active cGVHD patients had a profile consistent with T effector cell activation that was not present in TOL and CMV serostatus negative/active cGVHD patients. Pursuing latency, cytomegalovirus will try to evade the immune system attempts of viral clearance creating modifications varying from changes in lymphocyte subsets to chromatin remodeling by several enzymes and microRNA. The chronic GVHD characteristic inflammatory environment, increased cytokine production, immunosuppressive therapy, and impaired T cell immune reconstitution, may increase the risk of CMV reactivation, even if not detectable, followed by up-regulation of genes related to T cell activation and effector function. The PD-1 gene can be up-regulated in T cell activation and effector functions, but it also has an essential role in preventing the expansion and function of effector cells, being a candidate target for the prevention or treatment of chronic GVHD. Understanding the CMV impact on the PD-1 regulation in active cGVHD would be key on the implementation of new therapies.Thus, more studies in larger populations are needed in order to understand CMV previous infection immunomodulation impact in T cell function during chronic GVHD.

A infecção por citomegalovírus (CMV) tem efeito duradouro na distribuição dos subtipos de células T, mas pouco se sabe sobre o seu impacto na função celular. Foi realizada uma análise de expressão global gênica em células CD4+ purificadas em 38 recipientes de transplante de células tronco hematopoéticas (HSCT) (mediana de idade 48 anos; variação 20-65 anos) estudados em média cinco anos pós transplante (mediana 4.75 anos; variação 1-20 years). A população estudada incluiu 18 pacientes com GVHD crônico ativo (cGVHD) e 20 pacientes considerados tolerantes. Tolerância foi definida como ausência de sinais e sintomas de cGVHD, assim como ausência de tratamento imunossupressor (IST) por pelo menos 2 meses com seguimento de 1 ano sem tratamento imunossupressor. A expressão gênica foi medida por Illumina bead arrays. O seroestato do CMV foi definido pela sorologia pré transplante (por ELISA). Não havia evidência documentada de reativação do CMV no momento de coleta das amostras estudadas. Doze de 54 genes candidatos associados à função imune foram associados de maneira significativa com CMV+ em pacientes com cGVHD ativo (p<0.05) (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), sendo que somente três genes (CD14; CD86; IER3) foram associados a CMV+ entre os pacientes tolerantes. A expressão de PD-1 significativamente maior em pacientes CMV+ e com cGVHD ativo foi confirmada em uma população independente através de estudos de imunofenotipagem. Os pacientes CMV+/cGVHD ativos tiveram um perfil compatível com ativação de células T efetoras, não sendo detectado com a mesma intensidade em pacientes tolerantes e pacientes CMV-/cGVHD ativos. Tendo como objetivo a latência da infecção, o citomegalovírus tentará evadir-se das tentativas do sistema imune de depuração viral, criando modificações que vão desde mudanças nos subtipos de linfócitos até a remodelação de cromatina por uma série de enzimas e microRNA. O ambiente caracteristicamente inflamatório do cGVHD, a produção aumentada de citocinas, a terapia imunossupressora e a reconstituição imune defeituosa das células T podem aumentar o risco de reativação do CMV, mesmo indetectável, seguido por supra-regulação de genes relacionados à ativação de células T e função efetora. O gene PD-1 pode estar supra-regulado em ativação de células T e função efetora, mas tem papel essencial na prevenção da expansão e função das células T efetoras, sendo um candidato alvo para a prevenção e tratamento do cGVHD. Entender o impacto do CMV na regulação de PD-1 em pacientes com cGVHD seria instrumental na implementação de novas terapias; portanto mais estudos com populações maiores são necessários para entendermos o impacto da imunomodulação secundária à infecção prévia por CMV no funcionamento das células T durante cGVHD. / Cytomegalovirus infection (CMV) is known to have a life-long effect on the distribution of T cell subsets, but little is known about the impact on cell function. We performed a gene expression analysis in purified CD4+ T cells from 38 hematopoietic cell transplant (HCT) recipients (median age 48; range 20-65) studied on average 5 years after HCT (median 4.75; range 1-20 years). The study population included 18 patients with active chronic GVHD (cGVHD) and 20 tolerant (TOL) patients. Tolerance was defined by absence of signs, symptoms of cGVHD and immunosuppressive therapy (IST) for at least 2 months and 1 year follow-up without immunosupressive therapy . Gene expression was measured on Illumina bead arrays. CMV status was defined by pre-transplant recipient CMV serology (by ELISA). There was no recorded evidence of CMV reactivation at the time of study. Twelve of 54 candidate genes associated with immune function and inflammation were found to be associated CMV positive serostatus in cGVHD patients at a significance threshold of p<0.05 (PDCD-1; GZMH, IFNG, PRF1, CST7, IL18RAP, ITGAM, CTSW, ITGAL, GBP1, CDKN1B, CXCR4), but only three genes (CD14; CD86; IER3) were associated with CMV serostatus in TOL patients. The significant higher PD-1 expression on CD4+ cells of CMV+/active cGVHD patients was confirmed by immunophenotype testing in an independent population. CMV+/active cGVHD patients had a profile consistent with T effector cell activation that was not present in TOL and CMV serostatus negative/active cGVHD patients. Pursuing latency, cytomegalovirus will try to evade the immune system attempts of viral clearance creating modifications varying from changes in lymphocyte subsets to chromatin remodeling by several enzymes and microRNA. The chronic GVHD characteristic inflammatory environment, increased cytokine production, immunosuppressive therapy, and impaired T cell immune reconstitution, may increase the risk of CMV reactivation, even if not detectable, followed by up-regulation of genes related to T cell activation and effector function. The PD-1 gene can be up-regulated in T cell activation and effector functions, but it also has an essential role in preventing the expansion and function of effector cells, being a candidate target for the prevention or treatment of chronic GVHD. Understanding the CMV impact on the PD-1 regulation in active cGVHD would be key on the implementation of new therapies.Thus, more studies in larger populations are needed in order to understand CMV previous infection immunomodulation impact in T cell function during chronic GVHD.

Introduction: Chronic graft-versus-host disease (cGVHD) is a serious complication following allo-HSCT characterized by immune dysregulation, organ dysfunction, risk for infection, and distressing symptoms. Complications may include scleroderma, hepatic dysfunction and bronchiolitis obliterans. Advances in allo-HSCT for many hematologic dyscrasias (e.g. acute and chronic leukemias, aplastic anemia, and myelodysplastic syndrome) have improved survival which has generated a renewed focus on survivorship issues. Distressing symptoms are noted as negatively impacting quality of life (QoL). The relationship between inflammation and behavioral responses may impact symptoms. Examining patterns and levels of inflammation with symptoms is relevant. Objective: The aims of this study were to examine: 1) levels of symptoms (cGVHD specific, general symptoms, and cluster symptoms [pain, depression and fatigue]), inflammation (cytokines [Interleukin {IL}-1β, IL-6, IL-10, TNF, and INF-γ] and C-reactive protein [CRP]) and QoL in patients diagnosed with cGVHD and 2) relationships between and among symptoms, inflammation and QoL in individuals with cGVHD. Methods: A cross-sectional study design examined 24 individuals (ages 29-79) with cGVHD enrolled from an NCI-designated cancer center after obtaining informed consent. Data were collected using medical record and validated questionnaires. Plasma cytokine levels were measured using BioRad® multiplex assay. C-reactive protein levels were measures using an enzyme-linked immunosorbant assay. Statistical analyses included descriptive statistics and pairwise correlations. Results: A total of 24 participants (58.3% female) with cGVHD enrolled in this study. Multiple, concurrent symptoms were noted. Several pro-inflammatory cytokines were higher in participants with symptoms versus those without symptoms. IL-6 correlated with lack of energy (r= .42; p= .04) and dry mouth (r= .42; p= .04). IL-10 was correlated with difficulty sleeping (r= .43; p= .03). Sexual dysfunction correlated with social well-being (r= -.44; p=.03). Many symptoms negatively correlated with QoL. Conclusion: Findings from this study, one of the first to examine levels of symptoms and inflammatory markers in individuals with cGVHD, demonstrate significant relationships among symptoms, inflammation, and quality of life. The relationship of inflammatory biomarkers with symptoms emphasizes the need for further interdisciplinary research. Better understanding mechanisms associated with symptoms is necessary for the development and testing of targeted interventions to improve QoL for individuals with cGVHD.