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Fulminant Crohn's colitis after allogeneic stem cell transplantation.
S A Sonwalkar1, R M James, T Ahmad
1Molecular Medicine Unit, University of Leeds, and Department of Gastroenterology, St James's University Hospital, Leeds, UK.
Gut
|September 13, 2003
Summary
This case study suggests Crohn's disease may be adoptively transferred via stem cell transplants. Genetic analysis revealed donor-recipient mismatches, potentially explaining the colitis development.
Area of Science:
- Gastroenterology
- Immunology
- Hematology
Background:
- Adoptive transfer of inflammatory bowel disease (IBD) via hematopoietic cells is known in animal models.
- Remission of Crohn's disease (CD) has been observed post-bone marrow transplant.
- Phenotypic manifestation of CD post-transplant due to adoptive transfer of susceptibility has not been previously reported.
Observation:
- A patient developed fulminant Crohn's colitis after non-myeloablative allogeneic stem cell transplantation for Hodgkin's lymphoma.
- Infective causes of colitis were ruled out.
- Genetic analysis identified significant donor-recipient mismatches in HLA class III genes at the IBD3 locus.
Findings:
- The donor possessed a NOD2/CARD15 5' UTR polymorphism associated with Crohn's disease, while the recipient did not.
- This suggests a potential mechanism for adoptive transfer of Crohn's disease susceptibility.
- The findings point to donor-recipient genetic disparities in IBD susceptibility loci.
Implications:
- This case raises the possibility of adoptive transfer of Crohn's disease between allogeneic stem cell transplant donors and recipients.
- It highlights the need to consider donor screening for inflammatory bowel disease susceptibility.
- Further research is warranted to explore the role of genetic predisposition in transplant-mediated IBD.
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