Laboratory of Ocular Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Bone Marrow Transplant. 2024 Aug;59(8):1049-1056. doi: 10.1038/s41409-024-02321-3. Epub 2024 May 31.
Graft-versus-host disease is among the most common clinical complications following allogeneic hematopoietic stem cell transplantation. It causes inflammation-mediated destruction and dysfunction of various organ systems including ocular tissues in 60-90% of the patients and is termed ocular GVHD (oGVHD). In oGVHD, donor-derived T-cells recognize host antigens as foreign, resulting in immune dysregulation, inflammation and fibrosis of lacrimal glands, meibomian glands, cornea, and conjunctiva. The clinical presentation in oGVHD patients range from mild dry eye symptoms to catastrophic inflammation mediated pathological changes which can cause corneal perforation and blindness. In this review article, we provide detailed insights into the impact of mucosal barrier disruption, the afferent and efferent phases of immunological response involving activation of antigen presenting cells and T cells, respectively. We evaluate the evidence outlining the effector phase of the disease leading to cellular destruction and eventually fibrosis in patients with oGVHD. Finally, we discuss the well-established criteria for the diagnosis of oGVHD.
移植物抗宿主病是异基因造血干细胞移植后最常见的临床并发症之一。它导致炎症介导的破坏和功能障碍的各种器官系统，包括眼部组织在 60-90%的患者，并称为眼部移植物抗宿主病 (oGVHD)。在 oGVHD 中，供体来源的 T 细胞将宿主抗原识别为异己，导致免疫失调、泪腺、睑板腺、角膜和结膜的炎症和纤维化。oGVHD 患者的临床表现从轻度干眼症状到灾难性炎症介导的病理性改变不等，可导致角膜穿孔和失明。在这篇综述文章中，我们详细介绍了黏膜屏障破坏、免疫反应的传入和传出阶段的影响，分别涉及抗原呈递细胞和 T 细胞的激活。我们评估了导致 oGVHD 患者细胞破坏并最终纤维化的疾病效应阶段的证据。最后，我们讨论了 oGVHD 的诊断标准。
