Original article
Increased regulatory T cells and eosinophils characterize atopic dermatitis–like graft-versus-host disease compared with lichen planus–like graft-versus-host disease

https://doi.org/10.1016/j.jaad.2019.08.005Get rights and content

Background

Graft-versus-host disease (GVHD) has various cutaneous manifestations. Little is known about the mechanisms of cutaneous GVHD with different clinical features.

Objective

To characterize the immunologic features and skin barrier functions of cutaneous GVHD.

Methods

The study included 19 patients with atopic dermatitis (AD)-like GVHD, 8 with lichen planus (LP)-like GVHD, 24 with AD, and 15 healthy controls. The subpopulation of T cells in peripheral blood and skin lesions was measured by flow cytometry and immunofluorescence, respectively. Filaggrin expression in skin lesions was measured by Western blot and immunohistochemistry. Transepidermal water loss was also measured using Tewameter TM 300 (Courage & Khazaka Electronic GmbH, Köln, Germany).

Results

The number of peripheral blood eosinophils in AD-like GVHD was significantly higher than that in LP-like GVHD. Type 2 helper T cells in peripheral blood and skin lesions were increased in AD-like GVHD and LP-like GVHD. Regulatory T cells in peripheral blood and skin lesions were increased in AD-like GVHD. Filaggrin expression and transepidermal water loss were increased in skin lesions of AD-like GVHD and LP-like GVHD.

Limitations

The number of patients is limited.

Conclusion

Although AD-like GVHD and LP-like GVHD both had elevated type 2 helper T cells and impaired skin barrier, increased eosinophils and regulatory T cells were found only in AD-like GVHD.

Section snippets

Study participants

The study enrolled 19 patients with AD-like GVHD, 8 with LP-like GVHD, 24 with AD, and 15 healthy controls. Peripheral blood samples were obtained from all participants for measurement of eosinophils and subpopulations of T cells. Sera were obtained after centrifugation and stored at −80°C before analysis. Skin biopsies were performed in 5 patients with AD-like GVHD, 5 with LP-like GVHD, 6 with AD, and 8 healthy controls. The Peking University People's Hospital Ethics Committee reviewed and

Patient characteristics

The characteristics of patients with cutaneous GVHD are summarized in Table I. Increased peripheral blood eosinophils were found in 36.8% of patients with AD-like GVHD, significantly higher than that of LP-like GVHD (P = .011, Fig 1). Eosinophils were also found in the infiltration of the skin lesions of AD and AD-like GVHD (Fig 1). Elevated total serum immunoglobulin E was found in 63.2% of patients with AD-like GVHD and in 50.0% of patients with LP-like GVHD (data not shown).

Th cells in cutaneous GVHD

Th1 cells were

Discussion

Chronic cutaneous GVHD represents a wide range of clinical manifestations reflecting a spectrum of superficial (lichenoid) and deep (scleroderma-like) cutaneous inflammations. We previously reported AD-like GVHD.5 The clinical features of patients with AD-like GVHD include eczematous lesions, dry skin, and itching. The histopathologic changes of AD-like GVHD include epidermal spongiosis, scattered keratinocyte necrosis, and a sparse perivascular infiltration of lymphocytes and eosinophils.

Conclusion

AD-like GVHD and LP-like GVHD are 2 forms of cutaneous GVHD. This study demonstrated that total serum immunoglobulin E level and Th2 cells were elevated in AD-like GVHD and LP-like GVHD. Although skin barrier functions were impaired in AD-like GVHD and LP-like GVHD, the filaggrin expression was increased in both diseases. Increased eosinophils and Treg cells were found in AD-like GVHD, which might be associated with the favorable outcome of the disease.

References (29)

  • S. Weidinger et al.

    Loss-of-function variations within the filaggrin gene predispose for atopic dermatitis with allergic sensitizations

    J Allergy Clin Immunol

    (2006)
  • P.A. Wu et al.

    Cutaneous graft-versus-host disease—clinical considerations and management

    Curr Probl Dermatol

    (2012)
  • M.H. Jagasia et al.

    National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report

    Biol Blood Marrow Transpl

    (2015)
  • I. Ollivier et al.

    Dermatomyositis-like graft-versus-host disease

    Br J Dermatol

    (1998)

    • Cited by (0)

    Funding sources: Supported by the National Natural Science Foundation of China (No.81472879) and Peking University People's Hospital Scientific Research Development Funds (RDY2018-19).

    Conflicts of interest: None.

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    © 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.