Interleukin (IL)-32 was originally identified in natural killer cells and IL-2-activated human T lymphocytes. As T cells are activated in allogeneic transplantation, we determined the role of IL-32 in human mixed lymphocyte cultures (MLCs) and GVHD. In allogeneic MLCs, IL-32 increased two-fold in responding T cells, accompanied by five-fold increases of TNF␣, IL-6, and IL-8. After allogeneic hematopoietic cell transplantation, IL-32 mRNA levels in blood leukocytes were statistically significantly higher in patients with acute GVHD (n ؍ 10) than in serial samples from patients who did not develop acute GVHD (n ؍ 5; P ؍ .02). No significant changes in IL-32 levels were present in patients with treated (n ؍ 14) or untreated (n ؍ 8) chronic GVHD, compared with healthy controls (n ؍ 8; P ؍ .5, and P ؍ .74, respectively). As IL-32 is activated by proteinase-3 (PR3), we determined the effect of the serine protease inhibitor ␣-1 antitrypsin (AAT) on IL-32 levels and showed suppression of IL-32 and T-lymphocyte proliferation in MLCs. In an MHC-minor antigen disparate murine transplant model, preconditioning and postconditioning treatment with AAT resulted in attenuation or prevention of GVHD and superior survival compared with albumin-treated controls (80% vs 44%; P ؍ .04). These findings suggest that AAT modulates immune and inflammatory functions and may represent a novel approach to prevent or treat GVHD. (Blood. 2011;118(18):5031-5039)
IntroductionAn extensive literature describes the role of proinflammatory cytokines in the manifestations of conditioning-related toxicity in patients undergoing hematopoietic cell transplantation (HCT) and the immunologic interactions of donor and recipient cells that follow HCT. We were interested in determining specifically the involvement of IL-32 in the "cytokine storm" that has been described in the peri-HCT and post-HCT period. 1 For one, we and others have shown that tumor necrosis factor ␣ (TNF), which is consistently up-regulated in transplant recipients, is a potent inducer of IL-32. 2 Conversely, IL-32 has been shown to induce TNF, 2-5 suggesting the possibility of an amplification loop between these two cytokines. Secondly, IL-32 was originally identified in IL-2-activated T lymphocytes and natural killer (NK) cells, 6 supporting a potential role in T-cell activation and function after allogeneic HCT. Furthermore, IL-32 is present in supernatants of IL-12, IL-18, and IL-12 plus IL-18-stimulated human NK cells and in 7 the supernatant of concanavalin A-stimulated human PBMCs. 7 In addition, in patients with myelodysplastic syndrome who exhibit excessive apoptosis in hematopoietic cells, we reported, in agreement with others, that silencing of endogenous IL-32 significantly reduced apoptosis and the expression of other proinflammatory mediators. 3,8 Based on these data, we postulated a role for IL-32 in alloactivation and in GVHD. As IL-32 is activated via partial cleavage by proteinase-3 (PR3), 9 we hypothesized that the naturally occurring serine protease...