CD4⁺ T cells generated de novo from donor hemopoietic stem cells mediate the evolution from acute to chronic graft-versus-host disease

Acute and chronic graft-versus-host disease (GVHD) remain the major complications limiting the efficacy of allogeneic hemopoietic stem cell transplantation. Chronic GVHD can evolve from acute GVHD, or in some cases may overlap with acute GVHD, but how acute GVHD evolves to chronic GVHD is unknown. In this study, in a classical CD8⁺ T cell-dependent mouse model, we found that pathogenic donor CD4⁺ T cells developed from engrafted hemopoietic stem cells (HSCs) in C57BL/6SJL(B6/SJL, H-2^b) mice suffering from acute GVHD after receiving donor CD8⁺ T cells and HSCs from C3H.SW mice (H-2^b). These CD4⁺ T cells were activated, infiltrated into GVHD target tissues, and produced high levels of IFN-γ. These in vivo-generated CD4⁺ T cells caused lesions characteristic of chronic GVHD when adoptively transferred into secondary allogeneic recipients and also caused GVHD when administered into autologous C3H.SW recipients. The in vivo generation of pathogenic CD4⁺ T cells from engrafted donor HSCs was thymopoiesis dependent. Keratinocyte growth factor treatment improved the reconstitution of recipient thymic dendritic cells in CD8⁺ T cell-repleted allogeneic hemopoietic stem cell transplantation and prevented the development of pathogenic donor CD4⁺ T cells. These results suggest that de novogenerated donor CD4⁺ T cells, arising during acute graft-versus-host reactions, are key contributors to the evolution from acute to chronic GVHD. Preventing or limiting thymic damage may directly ameliorate chronic GVHD.