Helicobacter pylori Infection and Graft-versus-Host Disease

Abstract

The gastrointestinal (GI) tract is the main target site of graft-versus-host disease (GVHD). Diagnosis is based on endoscopic and histological findings. Helicobacter pylori (HP) is a Gram-negative spiral bacterium linked to gastritis, peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, and adenocarcinoma and is frequently observed on endoscopy in patients who have undergone transplantation. The role, if any, played by HP infection in the development of acute GVHD is unknown. We conducted a retrospective study between January 1, 1990, and December 31, 2008, of 338 upper GI endoscopies (gastroscopies) performed on patients who underwent allogeneic stem cell transplantation with clinical suspicion of GVHD (198 patients). Acute and chronic GVHD were confirmed from histological features in 97 patients (51.3%) and 68 patients (36%), respectively. HP infection was detected in 69 patients (35%) and had a negative modulating effect on the development of acute GVHD (relative risk [RR], 0.60; 95% confidence interval, 0.46-0.79; P = .001) and chronic GVHD (RR, 0.75; 95% confidence interval, 0.61-0.92; P = .016). Furthermore, the presence of HP was inversely correlated with the histological severity of GVHD (P = .003). Our findings suggest that infection with HP may have a negative modulating effect on GVHD.

Potential protective effect of Helicobacter pylori on the development of gastrointestinal GvHD

“…Although in the paper by Correia-Silva et al, 38 no relationship between HP infection and the development of GvHD was observed in 46 patients who received an allogeneic transplant, our group reported in a retrospective study 15 with 198 patients that HP infection had a negative modulating effect on the development of acute GvHD (RR = 0.60 (95% CI: 0.46-0.79) P = 0.001) and chronic GvHD (RR = 0.75; (95% CI: 0.61-0.92) P = 0.016). Furthermore, the presence of HP was inversely correlated with the histological severity of GvHD (P = 0.003).…”

“…This represents a significant selection bias. 15 We now report our results from a prospective study of patients whose HP infection state was determined before transplant. The hypothesis to be tested was that pre-HCT HP infection was associated with a lower frequency of GI-GvHD than in HP-non-infected patients.…”

Autophagy differentially regulates tissue tolerance of distinct target organs in graft-versus-host disease models

“…Graft-versus-host disease (GVHD) is a complex pathogenic immunological consequence of allogeneic hematopoietic stem cell transplantation (allo-HSCT) that causes injury to specific organs like the gastrointestinal (GI) tract, liver, and skin and leads to significant clinical mortality and morbidity. Damage to these target tissues is incurred from the alloreactive donor T cells that recognize the disparate major or minor histocompatibility antigens on the host tissues ( 1 – 5 ). Strategies to prevent and alleviate GVHD focus exclusively on suppressing immune responses, which might result in infectious complications and relapse of the primary disease.…”