Glucagon-like peptide 2 for intestinal stem cell and Paneth cell repair during graft-versus-host disease in mice and humans

  • Johana Norona
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Petya Apostolova
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Dominik Schmidt
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Rebekka Ihlemann
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Nadine Reischmann
    Faculty of Biology, and
  • Gregory Taylor
    Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Medical Center, Durham, NC;
  • Natalie Köhler
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Jocelyn de Heer
    Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
  • Steffen Heeg
    Department of Medicine II and
  • Geoffroy Andrieux
    Institute of Medical Bioinformatics and Systems Medicine, MCUF, Faculty of Medicine, University of Freiburg, Freiburg, Germany;
  • Annette Schmitt-Graeff
    University of Freiburg, Freiburg, Germany;
  • Dietmar Pfeifer
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Antonella Catalano
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Ian J. Frew
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),
  • Michele Proietti
    Institute for Immunodeficiency, and
  • Bodo Grimbacher
    Institute for Immunodeficiency, and
  • Alla Bulashevska
    Institute for Immunodeficiency, and
  • Ami S. Bhatt
    Hematology and
  • Tilman Brummer
    Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany;
  • Till Clauditz
    Institute of Pathology and
  • Tatjana Zabelina
    Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
  • Nicolaus Kroeger
    Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
  • Bruce R. Blazar
    Masonic Cancer Center and
  • Melanie Boerries
    Institute of Medical Bioinformatics and Systems Medicine, MCUF, Faculty of Medicine, University of Freiburg, Freiburg, Germany;
  • Francis Ayuk
    Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
  • Robert Zeiser
    Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg (MCUF),

抄録

<jats:title>Abstract</jats:title><jats:p>Acute graft-versus-host disease (GVHD) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). Although currently used GVHD treatment regimens target the donor immune system, we explored here an approach that aims at protecting and regenerating Paneth cells (PCs) and intestinal stem cells (ISCs). Glucagon-like-peptide-2 (GLP-2) is an enteroendocrine tissue hormone produced by intestinal L cells. We observed that acute GVHD reduced intestinal GLP-2 levels in mice and patients developing GVHD. Treatment with the GLP-2 agonist, teduglutide, reduced de novo acute GVHD and steroid-refractory GVHD, without compromising graft-versus-leukemia (GVL) effects in multiple mouse models. Mechanistically GLP-2 substitution promoted regeneration of PCs and ISCs, which enhanced production of antimicrobial peptides and caused microbiome changes. GLP-2 expanded intestinal organoids and reduced expression of apoptosis-related genes. Low numbers of L cells in intestinal biopsies and high serum levels of GLP-2 were associated with a higher incidence of nonrelapse mortality in patients undergoing allo-HCT. Our findings indicate that L cells are a target of GVHD and that GLP-2–based treatment of acute GVHD restores intestinal homeostasis via an increase of ISCs and PCs without impairing GVL effects. Teduglutide could become a novel combination partner for immunosuppressive GVHD therapy to be tested in clinical trials.</jats:p>

収録刊行物

  • Blood

    Blood 136 (12), 1442-1455, 2020-09-17

    American Society of Hematology

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