Pericapillary hemorrhage as criterion of severe human digestive graft-versus-host disease.
In an experimental model we demonstrated that endothelial cells of all organs are targets of the alloimmune reaction. Here, in 68 digestive biopsies, we found endothelial lesions by immunohistochemistry and ultrastructure in patients with severe acute graft-versus-host disease (GVHD). In contrast, no such endothelial cell alterations were found either in patients without GVHD or in nongrafted controls. In the biopsies with severe GVHD lesions, ultrastructure showed rupture of the capillary basal membrane and extravased red blood cells. These pericapillary hemorrhages were highly correlated with GVHD severity. In a separate cohort of 39 patients who underwent an allogeneic transplantation after a nonmyeloablative conditioning, 8 patients had intestinal biopsies. Three of these latter patients had both severe pathologic lesions of GVHD and similar endothelial lesions, thus, strengthening the concept that endothelial lesions are linked to GVHD severity and not to the intensity of the conditioning regimen. (Blood. 2004;103:4681-4684)
Ertault-Daneshpouy
Marjan
M
INSERM ERM 0220, Hôpital Saint Louis, AP-HP, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.
Leboeuf
Christophe
C
Lemann
Marc
M
Bouhidel
Fatiha
F
Ades
Lionel
L
Gluckman
Eliane
E
Socié
Gérard
G
Janin
Anne
A
D001706:Biopsy; D002196:Capillaries; D004066:Digestive System Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D004730:Endothelium, Vascular / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*