Limited impact of imatinib in a murine model of sclerodermatous chronic graft-versus-host disease (scl-cGVHD)

- Introduction: Graft-versus-host disease (GVHD) remains one of the major complications following haematopoietic stem cell transplantation (HSCT). Approximately 15% of the patients with chronic GVHD develop the sclerodermatous form of the disease characterized by multiple organ fibrosis and loss of skin elasticity. Several studies have shown the potential benefits of imatinib, a tyrosine kinase inhibitor (TKI), as a treatment of fibrosis in cGVHD due to its ability to inhibit simultaneously PDGF-R and c-Abl pathways which are both involved in fibrosis mechanisms.

- Aims: Some early-phase clinical studies have assessed the impact of TKIs in patients with steroid-refractory cGVHD. Unfortunately, these studies yielded to conflicting results underlying the importance of re-assessing the impact of imatinib in scl-cGVHD pre-clinical models. This work investigates the possible benefits of imatinib on fibrosis in a murine model of sclerodermatous chronic GVHD (scl-cGVHD).

- Methods and results: Lethally irradiated Balb/cJ mice (7 Gy TBI) were injected i.v. with 1.106 or 10.106 bone marrow cells and 2.106 or 70.106 splenocytes from B10.D2 donnor mice (Moderate and Classical scl-cGVHD models respectively). Mice were then treated with sterile water or imatinib (150 mg/kg/day) by oral gavage from day +7 to day +52 following transplantation. cGVHD severity was assessed three times/week with a scoring system encompassing 5 criteria (mice posture, weight loss, activity, hair loss, skin integrity ; 0-1-2 point(s)/criteria). Skin biopsies were performed on day +29 following transplantation to assess phosphorylation of c-Abl (TGF-β pathway) and PDGF receptor.
Our results show that imatinib failed to prevent/improve GVHD with a similar evolution of the GVHD severity with no differences between groups (neither in moderate cGVHD model, nor in the classical cGVHD model). Mice weight loss during the experiments was also comparable between groups in both models of cGVHD. In the classical model, histological analyses indicate a significant reduction of the phosphorylation level of the PDGR receptor (p = 0.0079). In vivo cell proliferation assay with CFSE were also performed and showed a reduced proliferation of T cells and subsets (CD4, CD8 and Tregs) in spleen, lymph nodes, bone marrow and blood after imatinib treatment. Finally, FACS analyses performed on days +21 and +35 after transplantation did not show any differences in the absolute T-cell counts.

- Conclusions: Although we have observed a decreased phosphorylation level of PDGR receptor and less proliferation of T cells and subsets in vivo, imatinib failed to alleviate scl-cGVHD both in moderate and classical murine models of scl-cGVHD.