Abstract
Recent experimental evidence suggests that dysregulation of complex cytokine networks occurring in three sequential steps is responsible for many of the systemic manifestations of acute graft versus host disease (GVHD) (Figure 1). The first step of GVHD pathophysiology begins with the transplant conditioning regimen, which in clinical BMT includes total body irradiation (TBI) and/or chemotherapy. The conditioning is an important variable in the pathogenesis of acute GVHD because it damages and activates host tissues, including intestinal mucosa, liver and skin. Activated host cells then secrete inflammatory cytokines, e.g. tumor necrosis factor (TNF-a) and IL-1. The presence of inflammatory cytokines during this phase may upregulate adhesion molecules and MHC antigens by mature donor T cells in the second step of acute GVHD. This inflammatory context helps to explain the observation that enhanced risk of GVHD after clinical BMT is associated with certain intensive conditioning regimens that cause extensive injury to epithelial and endothelial surfaces and the subsequent release of inflammatory cytokines.
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© 1999 Springer Science+Business Media New York
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Ferrara, J.L.M., Holler, E., Blazar, B. (1999). Monoclonal Antibody and Receptor Antagonist Therapy for GVHD. In: Burt, R.K., Brush, M.M. (eds) Advances in Allogeneic Hematopoietic Stem Cell Transplantation. Cancer Treatment and Research, vol 101. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4987-1_15
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