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While rodent graft-versus-host disease (GVHD) models have suggested that indoleamine 2, 3-dioxygenase (IDO) is a critical regulator of gastrointestinal GVHD parallel human studies on IDO expression have not been reported. IDO expression was assessed in 20 patients who underwent duodenal biopsy. IDO was upregulated in epithelial cells. In situ analyses reveal that macrophages and dendritic cells stain positive for IDO, but that most of the IDO+ cells were a novel population of CD3+CD4+IDO+ cells. The proportion of CD4+IDO+ T-cells was significantly higher in patients with moderate GVHD. In situ regulatory T-cell and Th17 numbers correlated with overall severity. Although needing confirmatory results from larger sample sets, these data are consistent with the hypothesis that IDO is involved in regulating gastrointestinal GVHD.

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