Keywords: Chronic GVHD r HSCT r IL-21 r Th17Additional supporting information may be found in the online version of this article at the publisher's web-site
IntroductionAllogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered an effective treatment method for hematological malignancies, but graft-versus-host disease (GVHD) is a potentially lethal complication after allo-HSCT. Chronic GVHD (cGVHD) is not only a major cause of nonrelapse mortality but also induces substantial morbidity, which can severely affect the quality of life [1,2]. Despite improvements in the practice of allo-HSCT over the Correspondence: Prof. Xiao-Jun Huang e-mail: xjhrm@medmail.com.cn last 30 years, there has been little change in the incidence, morbidity, and mortality of cGVHD. One of the difficulties in combating cGVHD is the poor understanding of its pathogenesis [3].Chronic GVHD differs from acute GVHD (aGVHD) in many aspects. cGVHD often presents with clinical manifestations that resemble those observed in autoimmune diseases, such as systemic lupus erythematosus, Sjögren's syndrome, lichen planus, and scleroderma. However, in contrast to aGVHD, it is unclear how autoimmune responses develop in cGVHD [3,4].IL-17-producing CD4 + T lymphocytes, named Th17 cells, play a crucial role in triggering inflammation and tissue injury in several autoimmune diseases [5]. Increasingly, the Th17 differentiation pathway has been shown to play important roles in aGVHD [6,7]. We previously demonstrated that IL-17-producing C 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu Eur. J. Immunol. 2013. 43: 838-850 Clinical immunology
839T cells contribute to aGVHD after allogeneic blood marrow transplantation [8]. However, the role of Th17 cells in cGVHD is controversial [7,[9][10][11]. Using the B10.D23→BALB/c cGVHD model, Nishimori et al. [9] show that cGVHD is significantly ameliorated in recipients of IL-17 −/− B10. D2 donor T cells compared with recipients of wild-type T cells, suggesting that Th17 cells contribute to cGVHD in this model. However, the (B6→BALB/c)→B6 Rag cGVHD model of Chen et al. [10] shows that cGVHD is not significantly ameliorated in recipients transplanted with IL-17 −/− B6 donor T cells, suggesting that IL-17 is not required for autoimmune-mediated pathologic damage during cGVHD. Furthermore, recent clinical data have also demonstrated contradictory roles for IL-17 as a central mediator of cGVHD pathology [7,11]. The work of Dander et al. [7] demonstrates an increased Th17-cell population in patients with cGVHD in addition to an inflammatory process. However, Ratajczak et al. [11] found that although skin-infiltrating Th17 cells can be identified by immunohistochemistry through IL-17A expression, the Th17/Treg-cell ratio is significantly lower than that observed in non-GVHD controls, which argues against a pathogenic role for the Th17 subset. Therefore, the role of Th17 cells in the pathogenesis of cGVHD must be further explored. Moreover, a recent study has shown that IL-21, one of the m...