Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation / 器官移植

Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.

Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model

ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.

Using recipient free edge fingernails for chimerism analysis following allogeneic hematopoietic stem-cell transplants / 中华检验医学杂志

ObjectiveTo examine whether DNA extracted from free edge fingernails specimens from patient after hematopoietic stem cell transplantation (allo-HSCT) could be used for short tandem repeat (STR) genotyping and chimerism analyzing,and to observe the chimerism status in fingernails after allo-HSCT.MethodsPeripheral blood,bone marrow,oral mucosa and free edge fingernail specimens were collected from 25 patients which allo-HSCT were performed in Beijing Dao-pei Hospital during Jul.2009 to Sep.2011 and their donor.Genomic DNA was extracted and 15 STR loci genotyping and chimerism analysis were performed.For the first group which including 12 patients,pairs of fingernail and oral mucosa specimens were collected within one month after allo-HSCT and were comparative analyzed.For the second group which including 13 patients,chimerism status in fingernail samples were analyzed 3 months or longer after allo-HSCT,and 3 patients underwent repeated testing at different times.ResultsFor the first group,4 oral mucosa specimens showed donor chimerism with varying degrees,but no donor chimerism was detected.in all of 12 fingernail specimens.For the second group,6.7％ to 82.6％ donor chimerism was detected in fingernail specimens in 5 out of 13 patients.For the 3 patients underwent repeated testing,donor chimerism was continued negative in one cases,but continued positive in the other 2 cases.ConclusionsFree edge fingernail samples of patients within one month after allo-HSCT can be used for STR typing and chimerism analysis,and it is better than oral mucosa samples.There are cells in allo-HSCT donor graft can differentiate into skin cells,donor derived skin cells chimerism can be formed and persist in some patients.Med,2012,35:23-26)

Two Cases of Chronic Cutaneous Graft-versus-host-reaction on the Site of Healed Herpes Zoster as an Isotopic Response / 대한피부과학회지

The term 'isotopic response' was coined by Wolf to describe the emergence of a new skin disease at the site of another, unrelated, and already healed skin disease; most commonly herpes zoster. In the dermatologic literature, although a number of cutaneous lesions have been observed to develop at the site of healed herpes zoster, chronic cutaneous graft-versus-host reaction has been rarely reported. We herein report two cases of chronic cutaneous graftversus-host reaction which clinically presented as an isotopic response.

A Case of Acute Follicular Graft versus Host Reaction / 대한피부과학회지

Acute graft-versus-host disease (GVHD) is a life threatening complication of allogeneic bone marrow transplantation. It is important to recognize the dermatologic manifestations of acute GVHD, as skin is often the initial organ of involvement. The rash typically is a blanchable, erythematous macular eruption. We present a case of acute follicular graft-versus-host reaction (GVHR) characterized by erythematous to violaceous follicular papular eruption clinically and follicular epithelial dyskeratosis histopathologically. Although acute follicular GVHR is rare, it is important to recognize it as an early skin manifestation of acute cutaneous GVHR allowing prompt therapy.

Cutaneous Graft versus Host Reaction: Clinicopathologic Study / 대한피부과학회지

BACKGROUND: Graft-versus-host disease(GVHD) frequently produces cutaneous and systemic complications in patients receiving allogenic bone marrow transplantation. Familiarity with these reactions and their treatment is important to dermatologists involved in the care of bone marrow transplant recipients. OBJECTIVE: Our purpose was to find the clinical and histopathological features of cutaneous graft versus host reaction(GVHR). METHODS: We retrospectively reviewed patients who had undergone cutaneous GVHR after allogenic bone marrow transplantation in our institute over ten years. RESULTS AND CONCLUSION: 1.We found GVHD in 40% patients with allogenic bone marrow transplantation. 2.There was cutaneous GVHR in 86.5%, liver GVHR in 44.2% and gastrointestinal systems involvement in 34.6% of all GVHD patients. 3.Acute cutaneous GVHR presented as a generalized maculopapular exanthem and chronic cutaneous GVHR appeared as generalized maculopapular eruptions or lichenoid lesions. 4.Histopathologically, in 65.4%(17/26) of acute GVHR showed characteristic changes such as basal cell degeneration, dyskeratotic cells in epidermis, spongiosis, subepidermal cleft, and inflammatory cell infiltration and in 78.3% of chronic GVHR revealed acute GVHR-like or lichenoid change. 5.Treatment of moderate to severe GVHD consisted of high-dose corticosteroids and cyclosporine. There were 23.1% mortality due to sepsis in GVHD patients.

A Histopathological Comparative Study between Erythema Multiforme and Acute Cutaneous Graft - versus - Host Reactions / 대한피부과학회지

BACKGROUND: The histopathological findings of acute cutaneous graft-versus-host reaction are similar to that of erythema multiforme. OBJECTIVE: The objective of this study was to compare the histopathological findings of acute cutaneous graft-versus-host reactions with that of erythema multiforme. METHODS: Histopathological setions of 9 patients with grade 2 acute cutaneous graft-versus- host. reactions and of 13 patient,, with erythema multiforme were reviewed. RESULTS: Parakeratosis, the degree of the exocytosis and the endothelial cell swelling were not useful in the differential diagnosis between acute cutaneous graft-versus-host reactions and ery- thema multiforme. Rete ridge effacement and relative hyperkeratosis were characteristic in many cases of acute cutaneous graft-versus-host reactions but absent in erythema multiforme. Spongiosis, vacuolar degeneration of the basal cells, perivascular lymphocytic infiltration and erythrocyte extravasation were usually more prominent in erythema multiforme than in acute cutaneous graft-versus-host reactions. The number of dyskeratotic cells per epidermal linear mm was usually higher in erythema multiforme but not in acute cutaneous graft-versus-host reactions. An eosinophilic infiltrate was observed occasionally in erythema multiforme but not in acute cutaneous graft-versus-host reactions. CONCLUSION: The histopathological findings show the same pattern of interface dermatitis and are different only in degree beween acute cutaneous graft-versus-host reactions and eryt,hema multiforrne. Rete ridge effacement and relative hyperkeratosis speaks for a diagnosis of acute cutaneous graft-versus-host reactions, and an eosinophilic infiltrate for a diagnosis of erythema multiforme.

Immunological Mechanisms of Inhibition of GVHR by Ch. Violaceum Endotoxin / 第二军医大学学报

We had confirmed that treatment of donor mice with Ch. Violaceum endotoxin (lipopolysacchari-de,LPS)could inhibit GVHR. In this paper, its immunological mechanisms were explored. The results showed that the LPS could augment [3H] -TdR uptake by mouse spleen cells, but decrease their proliferative responses to LPS and Con A, and suppress unidirectional MLR and NK cell activity, with inhibitory rate of 64.5%, 66.1%, 51.7% and 59.3%, respectively, suggesting it had inhibitory effects on B, T lymphocytes and NK cells. In vitro experiments using mixtures of spleen cells from treated and normal mice showed there existed non-specific suppressor cell activity in LPS-and Con A-induced lymphocyte transformation but not in MLR and NK activity assays. That meant suppressor cells were not responsible for suppressive effects on T cells and NK cells which are thought to be main effector cells mediating GVHD.