Bile acids regulate intestinal antigen presentation and reduce graft-versus-host disease without impairing the graft-versus-leukemia effect

Haematologica. 2021 Aug 1;106(8):2131-2146. doi: 10.3324/haematol.2019.242990.

Abstract

Acute graft-versus-host disease causes significant mortality in patients undergoing allogeneic hematopoietic cell transplantation. Immunosuppressive treatment for graft-versus-host disease can impair the beneficial graft-versus-leukemia effect and facilitate malignancy relapse. Therefore, novel approaches that protect and regenerate injured tissues without impeding the donor immune system are needed. Bile acids regulate multiple cellular processes and are in close contact with the intestinal epithelium, a major target of acute graft-versus-host disease. Here, we found that the bile acid pool is reduced following graft-versus-host disease induction in a preclinical model. We evaluated the efficacy of bile acids to protect the intestinal epithelium without reducing anti-tumor immunity. We observed that application of bile acids decreased cytokine-induced cell death in intestinal organoids and cell lines. Systemic prophylactic administration of tauroursodeoxycholic acid, the most potent compound in our in vitro studies, reduced graft-versus-host disease severity in three different murine transplantation models. This effect was mediated by decreased activity of the antigen presentation machinery and subsequent prevention of apoptosis of the intestinal epithelium. Moreover, bile acid administration did not alter the bacterial composition in the intestine suggesting that its effects are cell-specific and independent of the microbiome. Treatment of human and murine leukemic cell lines with tauroursodeoxycholic acid did not interfere with the expression of antigen presentation-related molecules. Systemic T cell expansion and especially their cytotoxic capacity against leukemic cells remained intact. This study establishes a role for bile acids in the prevention of acute graft-versus-host disease without impairing the graft-versus-leukemia effect. In particular, we provide a scientific rationale for the systematic use of tauroursodeoxycholic acid in patients undergoing allogeneic hematopoietic cell transplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antigen Presentation
  • Bile Acids and Salts
  • Graft vs Host Disease* / prevention & control
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Intestines
  • Leukemia*
  • Mice
  • Transplantation, Homologous

Substances

  • Bile Acids and Salts

Grants and funding

Funding: This study was supported by the Else Kröner-Fresenius-Stiftung (EKFS 2015_A147 to PA), the INTERREG V European regional development fund (European Union) program (project 3.2 TRIDIAG to RZ), Wilhelm Sander Stiftung (grant 2008.046.5 to RZ), Deutsche Forschungsgemeinschaft, Germany, SFB1160 (RZ) and SFB850 (MB), ERC Consolidator grant (681012 GvHDCure European Union, to RZ and by the Excellence Strategy of the German Federal and State Governments (CIBSS - EXC 2189). PA is supported by a scholarship from the Berta Ottenstein Program for Physician Scientists, Faculty of Medicine, Medical Center – University of Freiburg, Germany. MB is supported by the German Federal Ministry of Education and Research (BMBF) within the framework of the e:Med research and funding concept (CoNfirm, FKZ 01ZX1708F) and within the Medical Informatics Funding Scheme (MIRACUM, FKZ 01ZZ1606A-H). BG receives support through the Deutsche Forschungsgemeinschaft (DFG) SFB1160/2_B5, under Germany's Excellence Strategy (CIBSS – EXC-2189 – Project ID 390939984, and RESIST – EXC 2155 – Project ID 39087428); through the E-rare program of the EU, managed by the DFG, grant code GR1617/14-1/iPAD; and through the „Netzwerke Seltener Erkrankungen“ of the German Ministry of Education and Research (BMBF), grant code: GAIN_01GM1910A.