[HTML][HTML] Ibrutinib treatment ameliorates murine chronic graft-versus-host disease

JA Dubovsky, R Flynn, J Du… - The Journal of …, 2014 - Am Soc Clin Investig
JA Dubovsky, R Flynn, J Du, BK Harrington, Y Zhong, B Kaffenberger, C Yang, WH Towns…
The Journal of clinical investigation, 2014Am Soc Clin Investig
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 …
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.
The Journal of Clinical Investigation