New Insight for the Diagnosis of Gastrointestinal Acute Graft-versus-Host Disease

Malard, Florent; Mohty, Mohamad

doi:10.1155/2014/701013

Cited by 39 publications

(32 citation statements)

References 63 publications

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Section: Diagnosismentioning

confidence: 99%

“…The disease distribution identified by capsule endoscopy ranges from scattered lesions to contiguous enteritis 93 . Findings include normal mucosa, diffuse erythema, mucosal oedema, erosions and ulceration 93 . In one small trial that involved a cohort of 13 patients, capsule endoscopy showed high sensitivity (100%) and negative predictive value for diagnosis of acute GVHD 94 .…”

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

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Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomarkers have not yet been validated outside of clinical trials, endoscopic and histopathological evaluation continue to be utilized in diagnosis. Once a diagnosis of gastrointestinal acute GVHD is established, therapy with systemic corticosteroids is typically initiated, and non-responders can be treated with a wide range of second-line therapies. In addition to treating the underlying disease, the management of complications including profuse diarrhoea, severe malnutrition and gastrointestinal bleeding is paramount. In this Review, we discuss strategies for the diagnosis and management of acute GVHD of the gastrointestinal tract as they pertain to the practising gastroenterologist.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

126

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“…Dramatic differences in response rate with disease stage have been reported including 63% to 95% for grade II, 17% to 30% for grade III, and 0% to 6% for grade IV patients (7). Unfortunately, early aGVHD diagnosis is difficult due to its non-specific symptoms and numerous differential diagnoses (8), and typically a diagnosis occurs when overt symptoms such as skin, GI, or liver problems become apparent (9). Invasive endoscopic guided biopsy (often from liver or GI tract) are required to confirm an aGVHD(4), but bleeding tendency and critical illness associated with HCT make it near impossible to perform these procedures.…”

Section: Introductionmentioning

confidence: 99%

A PET Imaging Strategy to Visualize Activated T Cells in Acute Graft-versus-Host Disease Elicited by Allogenic Hematopoietic Cell Transplant

et al. 2017

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A major barrier to successful use of allogeneic hematopoietic cell transplantation is acute graft-versus-host disease (aGVHD), a devastating condition that arises when donor T cells attack host tissues. With current technologies, aGVHD diagnosis is typically made after end-organ injury and often requires invasive tests and tissue biopsies. This impacts patient prognosis as treatments are dramatically less effective at late disease stages. Here we show that a novel positron emission tomography (PET) radiotracer, 2′-deoxy-2′-[18F]fluoro-9-β-D-arabinofuranosylguanine ([18F]F-AraG), targeted towards two salvage kinase pathways preferentially accumulates in activated primary T cells. [18F]F-AraG PET imaging of a murine aGVHD model enabled visualization of secondary lymphoid organs harboring activated donor T cells prior to clinical symptoms. Tracer biodistribution in healthy humans showed favorable kinetics. This new PET strategy has great potential for early aGVHD diagnosis, enabling timely treatments and improved patient outcomes. [18F]F-AraG may be useful for imaging activated T cells in various biomedical applications.

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“…However, despite the differentiation capacity of the ESCs and iPSCs, potential tumorigenesis, ethical concerns, and graft versus host disease (GVHD) are the major challenges in development and clinical application of these cells (Brind'Amour 2012;Herberts et al 2011;Knoepfler 2009;Lodi et al 2011;Malard and Mohty 2014;Mertes and Pennings 2009;Takahashi et al 2007). …”

Section: Introductionmentioning

confidence: 99%

In vitro augmentation of mesenchymal stem cells viability in stressful microenvironments

Amiri

Jahanian-Najafabadi

Roudkenar

2015

Cell Stress and Chaperones

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Mesenchymal stem cells (MSCs) are under intensive investigation for use in cell-based therapies because their differentiation abilities, immunomodulatory effects, and homing properties offer potential for significantly augmenting regenerative capacity of many tissues. Nevertheless, major impediments to their therapeutic application, such as low proliferation and survival rates remain as obstacles to broad clinical use of MSCs. Another major challenge to evolution of MSC-based therapies is functional degradation of these cells as a result of their exposure to oxidative stressors during isolation. Indeed, oxidative stress-mediated MSC depletion occurs due to inflammatory processes associated with chemotherapy, radiotherapy, and expression of pro-apoptotic factors, and the microenvironment of damaged tissue in patients receiving MSC therapy is typically therapeutic not favorable to their survival. For this reason, any strategies that enhance the viability and proliferative capacity of MSCs associated with their therapeutic use are of great value. Here, recent strategies used by various researchers to improve MSC allograft function are reviewed, with particular focus on in vitro conditioning of MSCs in preparation for clinical application. Preconditioning, genetic manipulation, and optimization of MSC culture conditions are some examples of the methodologies described in the present article, along with novel strategies such as treatment of MSCs with secretome and MSC-derived microvesicles. This topic material is likely to find value as a guide for both research and clinical use of MSC allografts and for improvement of the value that use of these cells brings to health care.

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New Insight for the Diagnosis of Gastrointestinal Acute Graft-versus-Host Disease

Cited by 39 publications

References 63 publications

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

A PET Imaging Strategy to Visualize Activated T Cells in Acute Graft-versus-Host Disease Elicited by Allogenic Hematopoietic Cell Transplant

In vitro augmentation of mesenchymal stem cells viability in stressful microenvironments

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