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MEK inhibitors selectively suppress alloreactivity and graft-versus-host disease in a memory stage-dependent manner.

Authors:
Takero Shindo Tae Kon Kim Cara L Benjamin Eric D Wieder Robert B Levy Krishna V Komanduri

Blood 2013 Jun 10;121(23):4617-26. Epub 2013 Apr 10.

Adult Stem Cell Transplant Program and Department of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA.

Immunosuppressive strategies currently used in hematopoietic stem cell transplantation reliably decrease graft-versus-host disease (GVHD) rates, but also impair pathogen-specific immunity. Experimental transplant studies indicate that GVHD-initiating alloreactive T cells reside primarily in naive and central memory T-cell compartments. In contrast, virus-specific T cells comprise a more differentiated memory population. After finding that the rat sarcoma/mitogen-activated protein kinase kinase/extracellular receptor kinase (RAS/MEK/ERK) pathway is preferentially activated in naive and central memory human T cells, we hypothesized that MEK inhibitors would preferentially inhibit alloreactive T cells, while sparing more differentiated virus-specific T cells. Confirming our hypothesis, we found that MEK inhibitors including selumetinib preferentially inhibited cytokine production and alloreactivity mediated by naive and central memory human CD4(+) and CD8(+) T cells while sparing more differentiated T cells specific for the human herpesviruses cytomegalovirus and Epstein-Barr virus. We then demonstrated that short-term posttransplant administration of selumetinib in a major histocompatibility complex major- and minor-mismatched murine model significantly delayed the onset of GVHD-associated mortality without compromising myeloid engraftment, demonstrating the in vivo potential of MEK inhibitors in the setting of hematopoietic stem cell transplantation. These findings demonstrate that targeting memory-dependent differences in T-cell signaling is a potent and selective approach to inhibition of alloreactivity.

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http://dx.doi.org/10.1182/blood-2012-12-476218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674663PMC
June 2013

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