Ibrutinib treatment ameliorates murine chronic graft-versus-host disease
Jason A. Dubovsky, … , John C. Byrd, Bruce R. Blazar
Jason A. Dubovsky, … , John C. Byrd, Bruce R. Blazar
Published November 3, 2014; First published October 1, 2014
Citation Information: J Clin Invest. 2014;124(11):4867-4876. https://doi.org/10.1172/JCI75328.
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Categories: Research Article Immunology

Ibrutinib treatment ameliorates murine chronic graft-versus-host disease

Abstract

Chronic graft-versus-host disease (cGVHD) is a life-threatening impediment to allogeneic hematopoietic stem cell transplantation, and current therapies do not completely prevent and/or treat cGVHD. CD4+ T cells and B cells mediate cGVHD; therefore, targeting these populations may inhibit cGVHD pathogenesis. Ibrutinib is an FDA-approved irreversible inhibitor of Bruton’s tyrosine kinase (BTK) and IL-2 inducible T cell kinase (ITK) that targets Th2 cells and B cells and produces durable remissions in B cell malignancies with minimal toxicity. Here, we evaluated whether ibrutinib could reverse established cGVHD in 2 complementary murine models, a model interrogating T cell–driven sclerodermatous cGVHD and an alloantibody-driven multiorgan system cGVHD model that induces bronchiolar obliterans (BO). In the T cell–mediated sclerodermatous cGVHD model, ibrutinib treatment delayed progression, improved survival, and ameliorated clinical and pathological manifestations. In the alloantibody-driven cGVHD model, ibrutinib treatment restored pulmonary function and reduced germinal center reactions and tissue immunoglobulin deposition. Animals lacking BTK and ITK did not develop cGVHD, indicating that these molecules are critical to cGVHD development. Furthermore, ibrutinib treatment reduced activation of T and B cells from patients with active cGVHD. Our data demonstrate that B cells and T cells drive cGVHD and suggest that ibrutinib has potential as a therapeutic agent, warranting consideration for cGVHD clinical trials.

Authors

Jason A. Dubovsky, Ryan Flynn, Jing Du, Bonnie K. Harrington, Yiming Zhong, Benjamin Kaffenberger, Carrie Yang, William H. Towns, Amy Lehman, Amy J. Johnson, Natarajan Muthusamy, Steven M. Devine, Samantha Jaglowski, Jonathan S. Serody, William J. Murphy, David H. Munn, Leo Luznik, Geoffrey R. Hill, Henry K. Wong, Kelli K.P. MacDonald, Ivan Maillard, John Koreth, Laurence Elias, Corey Cutler, Robert J. Soiffer, Joseph H. Antin, Jerome Ritz, Angela Panoskaltsis-Mortari, John C. Byrd, Bruce R. Blazar

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Figure 3

Ibrutinib therapy prevents autoimmune injury in a T cell–dependent model of cGVHD.

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Ibrutinib therapy prevents autoimmune injury in a T cell–dependent model...
(A) Representative images from H&E-, B220-, or CD3-stained lung and kidney tissues from mice sacrificed at day 125 after HSCT from 6 mice/group. Images were taken by a trained veterinary pathologist who was blinded to animal cohorts. Original magnification, ×200. (B) Blinded pathologic analysis of H&E-stained lung tissues obtained from cGVHD cohorts (18 vehicle and 18 ibrutinib). Lymphohistiocytic infiltration was graded on a 0 to 4 scale for each animal. (C) Blinded pathologic analysis of H&E-stained kidney tissues obtained from cGVHD cohorts. Portal hepatitis and vasculitis were graded on a 0 to 4 scale for each animal. *P < 0.05; **P < 0.01. (D) Kaplan-Meier plot of cGVHD progression-free survival in an independent experiment aimed to determine sustained benefits from continued ibrutinib therapy. During the course of the experiment, ibrutinib was withdrawn on day 60 from animals in the Ibrutinib (day 25 to day 60) cohort. **P < 0.001.