Consideration of strategies for hematopoietic cell transplantation

Isaac Yaniv, Shifra Ash, Daniel L. Farkas, Nadir Askenasy, Jerry Stein

Research output: Contribution to journalArticlepeer-review

Abstract

Bone marrow transplantation has been adoptively transferred from oncology to the treatment of autoimmune disorders. Along with extension of prevalent transplant-related concepts, the assumed mechanism that arrests autoimmunity involves elimination of pathogenic cells and resetting of immune homeostasis. Similar to graft versus tumor (GVT) reactivity, allogeneic transplants are considered to provide a better platform of immunomodulation to induce a graft versus autoimmunity reaction (GVA). It is yet unclear whether recurrence of autoimmunity in both autologous and allogeneic settings reflects relapse of the disease, transplant-associated immune dysfunction or insufficient immune modulation. Possible causes of disease recurrence include reactivation of residual host pathogenic cells and persistence of memory cells, genetic predisposition to autoimmunity and pro-inflammatory characteristics of the target tissues. Most important, there is little evidence that autoimmune disorders are indeed abrogated by current transplant procedures, despite reinstitution of both peripheral and thymic immune homeostasis. It is postulated that non-specific immunosuppressive therapy that precedes and accompanies current bone marrow transplant strategies is detrimental to the active immune process that restores self-tolerance. This proposition refocuses the need to develop strategies of immunomodulation without immunosuppression.

Original languageEnglish
Pages (from-to)255-259
Number of pages5
JournalJournal of Autoimmunity
Volume33
Issue number3-4
DOIs
StatePublished - Nov 2009
Externally publishedYes

Keywords

  • Autoimmune disease
  • Bone marrow transplantation
  • Graft versus autoimmunity
  • Graft versus host
  • Graft versus tumor

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