Activated eosinophils in upper gastrointestinal tract of patients with graft-versus-host disease
Activated eosinophils in upper gastrointestinal tract of patients with graft-versus-host disease
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DOI：
10.1182/blood.v99.8.3033
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发表时间：
2002-04-15
期刊：
影响因子：
20.3
通讯作者：
Janin, A
中科院分区：
文献类型：
--
作者：
Daneshpouy, M;Socie, G;Janin, A
移植物抗宿主反应（GVHR）引起的消化道损伤导致高发病率和死亡率。诊断往往是晚的，因为活检时进行的临床症状是严重的，缺乏早期炎性病变的病理标志物。嗜酸性粒细胞是炎性细胞，在体外对消化上皮细胞具有细胞毒性;在炎症性肠病急性发作期间采集的活检标本中发现了嗜酸性粒细胞。我们在消化道症状发生后立即进行了系统的十二指肠活检，发现消化道GVHR发生率为73.1%（n = 93），高于在严重临床体征后立即进行消化道活检时的发生率。嗜酸性粒细胞仅存在于有GVHR的组织学体征时;嗜酸性粒细胞的存在与GVHR的严重程度相关。免疫金染色电子显微镜检查显示所有患者均出现原位嗜酸性粒细胞活化的病理学体征，例如细胞质颗粒改变和嗜酸性粒细胞过氧化物酶释放。白细胞介素-5在活化的嗜酸性粒细胞中的存在表明消化GVHR中嗜酸性粒细胞的募集是自分泌机制。嗜酸性粒细胞密度也与GVHR的严重程度相关，无论是在急性还是慢性临床阶段。因此，组织嗜酸性粒细胞可能是GVHR中急性炎症发作的标志物。在消化道症状发作时进行的系统性十二指肠活检应允许早期GVHR检测，GVHR的病理体征以及嗜酸性粒细胞密度可能有助于调节免疫抑制治疗。（血。2002;99：3033-3040）。(C)2002年，美国血液学会。
Digestive tract damage during graft-versus-host reaction (GVHR) causes high morbidity and mortality. Diagnosis is often late because biopsies are performed when clinical signs are severe and pathologic markers of early inflammatory lesions are lacking. Eosinophils are inflammatory cells, cytotoxic in vitro to digestive epithelium; they are found in biopsy specimens taken during acute flare-ups of inflammatory bowel disease, We performed systematic duodenal biopsies immediately after digestive symptoms occurred and found a digestive GVHR incidence of 73.1% (n = 93), higher than that found when digestive biopsies were performed immediately after severe clinical signs. Eosinophils were only present when there were histologic signs of GVHR; eosinophil presence correlated with GVHR severity. Electron microscopy with immunogold staining showed pathologic signs of in situ eosinophil activation, such as cytoplasmic granule alterations, and eosinophil peroxidase release in all patients. Interieukin-5 presence in activated eosin-ophils suggests eosinophil recruitment in digestive GVHR is an autocrine mechanism. Eosinophil density also correlated with GVHR severity, whether in acute or chronic clinical phases. Tissue eosinophils could thus be a marker of acute inflammatory flare-ups in GVHR. Systematic duodenal biopsy performed at the onset of digestive symptoms should allow early GVHR detection, and pathologic signs of GVHR, together with eosinophil density, might helps modulate immunosuppressive therapy. (Blood. 2002;99:3033-3040). (C) 2002 by The American Society of Hematology.