Transplantation of allogeneic hematopoietic cells faces two barriers: failure of engraftment due to a host versus graft reaction, and the attack of donor cells against the patient, the graft versus ...host (GVH) reaction. This reaction may lead to GVH disease (GVHD), but in patients transplanted due to leukemia or other malignant disorders, this may also convey the benefit of a graft versus leukemia (GVL) effect. The interplay of transplant conditioning with donor and host cells and the environment in the patient is complex. The microbiome, particularly in the intestinal tract, profoundly affects these interactions, directly and via soluble mediators, which also reach other host organs. The microenvironment is further altered by the modifying effect of malignant cells on marrow niches, favoring the propagation of the malignant cells. The development of stable mixed donor/host chimerism has the potential of GVHD prevention without necessarily increasing the risk of relapse. There has been remarkable progress with novel conditioning regimens and selective T-cell manipulation aimed at securing engraftment while preventing GVHD without ablating the GVL effect. Interventions to alter the microenvironment and change the composition of the microbiome and its metabolic products may modify graft/host interactions, thereby further reducing GVHD, while enhancing the GVL effect. The result should be improved transplant outcome.
Allogeneic transplantation of hematopoietic cells is an effective treatment of leukemia, even in advanced stages. Allogeneic lymphocytes produce a strong graft-versus-leukemia (GVL) effect, but the ...beneficial effect is limited by graft-versus-host disease (GVHD). Depletion of T cells abrogates GVHD and GVL effects. Delayed transfusion of donor lymphocytes into chimeras after T cell–depleted stem cell transplantation produces a GVL effect without necessarily producing GVHD. Chimerism and tolerance provide a platform for immunotherapy using donor lymphocytes. The allogeneic GVL effects vary from one disease to another, the stage of the disease, donor histocompatibility, the degree of chimerism, and additional treatment. Immunosuppressive therapy before donor lymphocyte transfusions may augment the effect as well as concomitant cytokine treatment. Possible target antigens are histocompatibility antigens and tumor-associated antigens. Immune escape of tumor cells and changes in the reactivity of T cells are to be considered. Durable responses may be the result of the elimination of leukemia stem cells or the establishment of a durable immune control on their progeny. Recently, we have learned from adoptive immunotherapy of viral diseases and HLA-haploidentical stem cell transplantation that T-cell memory may be essential for the effective treatment of leukemia and other malignancies.
Chronic GVHD, an autoimmune disease that follows allogeneic hematopoietic-cell transplantation, is characterized by infections and debilitating tissue injury leading to irreversible fibrosis. ...Insights into the pathophysiology of the disease are providing new therapeutic targets.
When T cells from a bone marrow donor begin to attack the host within 3 months after hematopoietic-cell transplantation, acute graft-versus-host disease results. The disease mainly affects the skin, ...liver, and gastrointestinal tract and is treated with immunosuppressive drugs.
The diversity of the human microbiome heralds the difference of the impact that gut microbial metabolites exert on allogenic graft-versus-host (GVH) disease (GVHD), even though short-chain fatty ...acids and indole were demonstrated to reduce its severity. In this study, we dissected the role of choline-metabolized trimethylamine N-oxide (TMAO) in the GVHD process. Either TMAO or a high-choline diet enhanced the allogenic GVH reaction, whereas the analog of choline, 3,3-dimethyl-1-butanol reversed TMAO-induced GVHD severity. Interestingly, TMAO-induced alloreactive T-cell proliferation and differentiation into T-helper (Th) subtypes was seen in GVHD mice but not in in vitro cultures. We thus investigated the role of macrophage polarization, which was absent from the in vitro culture system. F4/80+CD11b+CD16/32+ M1 macrophage and signature genes, IL-1β, IL-6, TNF-α, CXCL9, and CXCL10, were increased in TMAO-induced GVHD tissues and in TMAO-cultured bone marrow–derived macrophages (BMDMs). Inhibition of the NLRP3 inflammasome reversed TMAO-stimulated M1 features, indicating that NLRP3 is the key proteolytic activator involved in the macrophage's response to TMAO stimulation. Consistently, mitochondrial reactive oxygen species and enhanced NF-κB nuclear relocalization were investigated in TMAO-stimulated BMDMs. In vivo depletion of NLRP3 in GVHD recipients not only blocked M1 polarization but also reversed GVHD severity in the presence of TMAO treatment. In conclusion, our data revealed that TMAO-induced GVHD progression resulted from Th1 and Th17 differentiation, which is mediated by the polarized M1 macrophage requiring NLRP3 inflammasome activation. It provides the link among the host choline diet, microbial metabolites, and GVH reaction, shedding light on alleviating GVHD by controlling choline intake.
•Choline-derived or orally administered gut microbial metabolite TMAO aggravates GVHD.•TMAO enhances M1 macrophage polarization via NLRP3 inflammasome activation.
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This paper is a new step towards understanding why "quantum nonlocality" is a misleading concept. Metaphorically speaking, "quantum nonlocality" is Janus faced. One face is an apparent nonlocality of ...the Lüders projection and another face is Bell nonlocality (a wrong conclusion that the violation of Bell type inequalities implies the existence of mysterious instantaneous influences between distant physical systems). According to the Lüders projection postulate, a quantum measurement performed on one of the two distant entangled physical systems modifies their compound quantum state instantaneously. Therefore, if the quantum state is considered to be an attribute of the individual physical system and if one assumes that experimental outcomes are produced in a perfectly random way, one quickly arrives at the contradiction. It is a primary source of speculations about a spooky action at a distance. Bell nonlocality as defined above was explained and rejected by several authors; thus, we concentrate in this paper on the apparent nonlocality of the Lüders projection. As already pointed out by Einstein, the quantum paradoxes disappear if one adopts the purely statistical interpretation of quantum mechanics (QM). In the statistical interpretation of QM, if probabilities are considered to be objective properties of random experiments we show that the Lüders projection corresponds to the passage from joint probabilities describing all set of data to some marginal conditional probabilities describing some particular subsets of data. If one adopts a subjective interpretation of probabilities, such as QBism, then the Lüders projection corresponds to standard Bayesian updating of the probabilities. The latter represents degrees of beliefs of local agents about outcomes of individual measurements which are placed or which will be placed at distant locations. In both approaches, probability-transformation does not happen in the physical space, but only in the information space. Thus, all speculations about spooky interactions or spooky predictions at a distance are simply misleading. Coming back to Bell nonlocality, we recall that in a recent paper we demonstrated, using exclusively the quantum formalism, that CHSH inequalities may be violated for some quantum states only because of the incompatibility of quantum observables and Bohr's complementarity. Finally, we explain that our criticism of quantum nonlocality is in the spirit of Hertz-Boltzmann methodology of scientific theories.
Findings of retrospective studies suggest that sorafenib maintenance post-transplantation might reduce relapse in patients with FLT3 internal tandem duplication (FLT3-ITD) acute myeloid leukaemia ...undergoing allogeneic haematopoietic stem-cell transplantation. We investigated the efficacy and tolerability of sorafenib maintenance post-transplantation in this population.
We did an open-label, randomised phase 3 trial at seven hospitals in China. Eligible patients (aged 18–60 years) had FLT3-ITD acute myeloid leukaemia, were undergoing allogeneic haematopoietic stem-cell transplantation, had an Eastern Cooperative Oncology Group performance status of 0–2, had composite complete remission before and after transplantation, and had haematopoietic recovery within 60 days post-transplantation. Patients were randomly assigned (1:1) to sorafenib maintenance (400 mg orally twice daily) or non-maintenance (control) at 30–60 days post-transplantation. Randomisation was done with permuted blocks (block size four) and implemented through an interactive web-based randomisation system. The primary endpoint was the 1-year cumulative incidence of relapse in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02474290; the trial is complete.
Between June 20, 2015, and July 21, 2018, 202 patients were enrolled and randomly assigned to sorafenib maintenance (n=100) or control (n=102). Median follow-up post-transplantation was 21·3 months (IQR 15·0–37·0). The 1-year cumulative incidence of relapse was 7·0% (95% CI 3·1–13·1) in the sorafenib group and 24·5% (16·6–33·2) in the control group (hazard ratio 0·25, 95% CI 0·11–0·57; p=0·0010). Within 210 days post-transplantation, the most common grade 3 and 4 adverse events were infections (25 25% of 100 patients in the sorafenib group vs 24 24% of 102 in the control group), acute graft-versus-host-disease (GVHD; 23 23% of 100 vs 21 21% of 102), chronic GVHD (18 18% of 99 vs 17 17% of 99), and haematological toxicity (15 15% of 100 vs seven 7% of 102). There were no treatment-related deaths.
Sorafenib maintenance post-transplantation can reduce relapse and is well tolerated in patients with FLT3-ITD acute myeloid leukaemia undergoing allogeneic haematopoietic stem-cell transplantation. This strategy could be a suitable therapeutic option for patients with FLT3-ITD acute myeloid leukaemia.
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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.
Hematopoietic cell transplantation (HCT) is a critical treatment of patients with high-risk hematopoietic malignancies, hematological deficiencies, and other immune diseases. In allogeneic HCT ...(allo-HCT), donor-derived T cells recognize host tissues as foreign, causing graft-versus-host disease (GVHD) which is a main contributor to morbidity and mortality. The intestine is one of the organs most severely affected by GVHD and research has recently highlighted the importance of bacteria, particularly the gut microbiota, in HCT outcome and in GVHD development. Loss of intestinal bacterial diversity is common during the course of HCT and is associated with GVHD development and treatment with broad-spectrum antibiotics. Loss of intestinal diversity and outgrowth of opportunistic pathogens belonging to the phylum Proteobacteria and Enterococcus genus have also been linked to increased treatment-related mortality including GVHD, infections, and organ failure after allo-HCT. Experimental studies in allo-HCT animal models have shown some promising results for prebiotic and probiotic strategies as prophylaxis or treatment of GVHD. Continuous research will be important to define the relation of cause and effect for these associations between microbiota features and HCT outcomes. Importantly, studies focused on geographic and cultural differences in intestinal microbiota are necessary to define applicability of new strategies targeting the intestinal microbiota.
Cultural psychology has great potential to expand its research frameworks to more applied research fields in business such as marketing and organizational studies while going beyond basic ...psychological processes to more complex social practices. In fact, the number of cross-cultural business studies has grown constantly over the past 20 years. Nonetheless, the theoretical and methodological closeness between cultural psychology and these business-oriented studies has not been fully recognized by scholars in cultural psychology. In this paper, we briefly introduce six representative cultural constructs commonly applied in business research, which include (1) individualism vs. collectivism, (2) independence vs. interdependence, (3) analytic vs. holistic cognition, (4) vertical vs. horizontal orientation, (5) tightness vs. looseness, and (6) strong vs. weak uncertainty avoidance. We plot the constructs on a chart to conceptually represent a common ground between cultural psychology and business research. We then review some representative empirical studies from the research fields of marketing and organizational studies which utilize at least one of these six constructs in their research frameworks. At the end of the paper, we recommend some future directions for further advancing collaboration with scholars in the field of marketing and organizational studies, while referring to theoretical and methodological issues.
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