Gastrointestinal graft-versus-host disease (GVHD) is a common and potentially life-threatening complication after allogeneic hematopoietic stem-cell transplantation (HSCT). Noninvasive tests for assessment of GVHD activity are desirable but lacking. In the present study, we were able to visualize intestinal GVHDassociated inflammation in an allogeneic murine transplantation model by 18
IntroductionImproving results of allogeneic hematopoietic stem-cell transplantation (HSCT) have led to growing acceptance of this treatment as a potentially curative therapy for various malignant and nonmalignant diseases. [1][2][3][4][5][6][7] While the donor graft is enriched for hematopoietic progenitor and stem cells, it also contains T lymphocytes, which assist hematopoietic engraftment, restore T cell-dependent immunity, and are crucial to immunologic tumor control, usually referred to as graft-versus-tumor effect. 3,8 Besides these beneficial attributes, donor T cells are also responsible for graft-versus-host disease (GVHD), a leading cause of morbidity and lethality in patients who have undergone HSCT. 9,10 Depending on the source of the hematopoietic stem cell graft, the conditioning regimen, and the immunosuppressive treatment, the frequencies of acute GVHD vary from 20% to 50% in patients with an HLA-identical sibling donor, 11-13 and may reach 60% to 80% in patients with an HLAcompatible unrelated donor. 14 One remarkable feature of GVHD is its predilection for certain organ systems. Among them in descending frequency are the epithelial surfaces of the skin and mucous membranes, the crypts of the gastrointestinal tract, and the biliary ducts of the liver. About 80% of patients with acute GVHD have skin involvement, and more than 50% have gastrointestinal GVHD. 9,15 Intestinal GVHD is a progressive process that can affect all sections of the alimentary tract, albeit the terminal ileum and the colon are predominant sites. Symptoms are nonspecific and may include anorexia, nausea, vomiting, watery diarrhea, intestinal bleeding, abdominal pain, and ileus 16 that may also develop secondary to numerous other causes, such as infections, conditioning, and drug toxicity. [17][18][19][20] Although clinical investigation, laboratory tests, and histology usually lead to an early diagnosis of skin or liver GVHD, gastrointestinal GVHD is less readily diagnosed. 21 This is of particular concern, as GVHD remains one of the most detrimental complications after allogeneic transplantation, and the presence of gut involvement has been related to increased lethality and poor response to treatment. [22][23][24] Therefore, early recognition of intestinal GVHD is important, as prompt therapeutic intervention may prevent progression to higher-grade disease and improve outcome. [24][25][26][27][28][29] The current reference standard for diagnosis and staging of intestinal GVHD combines assessment of clinical symptoms with histologic analyses of mucosal biopsy specimens obtained by endoscopy of the upper and lower intestinal tract. 9 This appr...