Increased cell turnover, but no signs of increased T-cell infiltration or inflammatory cytokines in the duodenum of pediatric patients after allogeneic stem cell tranplantation

Mervi Taskinen, M. Westerholm-Ormio, R. Karikoski, H. Lindahl, G. Veres, E. Savilahti, U. M. Saarinen-Pihkala

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Intestinal immunopathology was studied after allogeneic stem cell transplantation (SCT) in a common clinical setup in 20 children with malignant (n = 17) or nonmalignant diseases (n = 3) receiving grafts from siblings (7) and unrelated donors (13). In all, 19 had total body irradiation. Duodenal biopsies at 6 and 12 weeks post transplant were evaluated by histology, immunohistochemistry, and ISEL for the detection of T-lymphocytes, inflammatory cytokines, proliferation, and apoptosis. The controls were 12 healthy children and three patients with proven intestinal graft-versus-host disease. An increased rate of apoptosis and proliferation with upregulated expression of HLA-DR antigen was detected up to 3 months post transplant in the SCT patients, even in those with a histologically normal small intestine. A low level of IFNγ and TNFα was observed in the lamina propria. The initial low density of γδ-positive T cells had recovered to normal by the time of the second endoscopy at 12 weeks post transplant. We conclude that inflammatory activity and T cell infiltration detected by immunohistochemistry may not belong to the 'normal' recovery of the small intestine after SCT. Increased cell turnover in the intestinal crypts continues until 3 months after SCT, suggesting either an unexpectedly long-lasting effect of transplant-related toxicity or, preferably, an ongoing subclinical alloreactive process, also present in the patients without intestinal symptoms.

Original languageEnglish
Pages (from-to)221-228
Number of pages8
JournalBone Marrow Transplantation
Issue number3
Publication statusPublished - Aug 1 2004



  • Graft-versus-host disease
  • Immunology
  • Intestine
  • Stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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