Activated eosinophils in upper gastrointestinal tract of patients with graft-versus-host disease

Abstract

Digestive tract damage during graft-versus-host reaction (GVHR) causes high morbidity and mortality. Diagnosis is often late because biopsies are performed when clinical signs are severe and pathologic markers of early inflammatory lesions are lacking. Eosinophils are inflammatory cells, cytotoxic in vitro to digestive epithelium; they are found in biopsy specimens taken during acute flare-ups of inflammatory bowel disease. We performed systematic duodenal biopsies immediately after digestive symptoms occurred and found a digestive GVHR incidence of 73.1% (n ‫؍‬ 93), higher than that found when digestive biopsies were performed immediately after severe clinical signs. Eosinophils were only present when there were histologic signs of GVHR; eosinophil presence correlated with GVHR severity. Electron microscopy with immunogold staining showed pathologic signs of in situ eosinophil activation, such as cytoplasmic granule alterations, and eosinophil peroxidase release in all patients. Interleukin-5 presence in activated eosinophils suggests eosinophil recruitment in digestive GVHR is an autocrine mechanism. Eosinophil density also correlated with GVHR severity, whether in acute or chronic clinical phases. Tissue eosinophils could thus be a marker of acute inflammatory flare-ups in GVHR. Systematic duodenal biopsy performed at the onset of digestive symptoms should allow early GVHR detection, and pathologic signs of GVHR, together with eosinophil density, might help modulate immunosuppressive therapy. (Blood. 2002;99:3033-3040)

Eosinophilia indicates the evolution to acute graft-versus-host disease

“…Goldammer et al's recent study 1 provides interesting data that appear to contradict the still widely held notion that there is an immunoglobulin G (IgG) feedback regulatory system and a resultant rebound in IgG synthesis following serum apheresis. Indeed, there is much evidence to corroborate that impression, as perhaps best exemplified by Junghans.…”

“…We have read with great interest the paper from Daneshpouy et al, 1 regarding the activated eosinophils in the upper gastrointestinal tract of patients with acute graft-versus-host disease (GVHD). The authors found that eosinophils were only present when there were histologic signs of GVHD.…”

Eosinophilic folliculitis in a patient after allogeneic bone marrow transplantation: Case report and review of the literature

“…However, the eruption is clinically indistinguishable from ordinary seborrheic eczema, so there is a chance that it could be misdiagnosed without a skin biopsy. Recent data has suggested that certain tissue eosinophilia might be a marker for GVHD in the digestive tract [8]. As skin is one of the main target organs in the GVHD together with gut, it is important to recognize this skin condition to avoid the inference that it may manifest itself as one of the signs of skin GVHD.…”

Eosinophilic cystitis following cord blood transplantation: a form of acute GVHD. A variant of hemorrhagic cystitis after hematopoietic SCT or drug-induced?

“…On admission, there were no notable findings regarding lymph nodes, liver or spleen size. Laboratory data demonstrated marked anemia with hemoglobin of 4.5 g per 100 ml, elevated leukocyte count of 29.5 Â 10 9 per l with blast cells in the peripheral blood (65%) and a decreased platelet count of 4.6 Â l0 4 per ml. Initially, the patient was treated with a combination of idarubicin and ara-C as induction chemotherapy, but this regimen was ineffective.…”

“…On activation, eosinophils release cationic granule proteins that exert cytotoxic effects on epithelial cells in vivo. 3 Daneshpouy et al 4 performed systematic duodenal biopsies immediately after gastric symptoms occurred and found that eosinophils were present only when there were histologic signs of GVHD; eosinophil presence correlated with GVHD severity, and they concluded that tissue eosinophil concentrations are a marker of acute inflammatory reaction during GVHD flare-ups. There are similar reports by Basara et al 5 in BM, based on a systematic prospective study of BM smears and biopsies.…”