Implications of TNF-α in the pathogenesis and management of GVHD

Clinical graft-versus-host disease (GVHD) symptoms are the result of a complex set of interactions between cellular and soluble factors. One of the key soluble factors is the proinflammatory cytokine, TNF-alpha, which participates in the initiating events that culminate in GVHD as well as amplifies the disease process once established. The importance of TNF-alpha in this process has been supported by a series of clinical experiments demonstrating strong correlation between TNF receptor-1 levels and GVHD. TNF-alpha has both indirect effects, through activating and proliferation pathways of T cells, the main cellular effector of GVHD, and direct effects leading to apoptosis, on GVHD target tissues. Accordingly, TNF-alpha has been used as a therapeutic target in experimental GVHD prevention and treatment strategies with promising clinical results. TNF-alpha can be pharmacologically inhibited using soluble TNF receptors or monoclonal antibodies. The optimal dosing and duration of TNF inhibition to prevent or treat GVHD remains under investigation.