Genetic constitution can be used to determine blood-disease patients' reaction to stem-cell transplants, according to the latest research by a team of doctors from the National Taiwan University Hospital and the Fred Hutchinson Cancer Research Center in Seattle.
"While stem-cell transplants are often the only treatment available to patients with blood disorders such as leukemia, aplastic anemia, Thalassemia and lymphocytic leukemia, adverse immune reactions often lead to fatal complications for many transplant recipients," said Tseng Li-hui (曾麗慧), a research team member at the NTU hospital medical genetics department.
Tseng explained that even with a perfect human lymphocyte antigen (HLA) match, which is commonly used to determine transplant compatibility, there is still a 20 percent chance of graft-versus-host disease (GVHD), during which the donated bone marrow reacts against the donor's own tissue.
However, doctors yesterday put forth that new findings indicated that the interleukin-10 genotype was intimately linked to the regulation of immune responses. Tseng explained that the medical breakthrough would allow doctors to identify patients who are at high risk of contracting GVHD with a simple genetic test.
The research confirmed that those with the A/A interleukin-10 genotype produce a greater amount of interleukin-10, which protects against GVHD and helps to ensure long-term transplant survival. At the same time, the C/C interleukin-10 genotype indicates a higher risk of GVHD after the transplant.
"Patients with the C/C interleukin-10 genotype are 2.6 times more likely to get GHVD than patients with the A/A genotype," Tseng said.
Chen Pei-jer (陳培哲), a NTU hospital doctor and research team member, explained the implications of the findings.
"In the future, a patient could be given cold medication depending on the patient's gene constitution. This is just the start of a study of the association between genetic make-up and immune responses," Chen said.
"Right now, the interleukin-10 genotype is just used to determine the risk of GVHD in transplant patients, but it may soon be possible to develop interleukin-10 injections that would help high risk patients," Chen said.
He said that the association between interleukin-10 and immune reactions would be useful for patients considering stem cell transplantation. It would furthermore aid in deciding on an appropriate immunosuppressive drug regimen for each patient.
In addition, the study found that the A/A interleukin-10 genotype was found in 67 percent of Japanese patients and 70 percent of Taiwanese patients, which is substantially higher than the 23 percent found in Caucasian patients. In the past, the lower incidence of GVHD in Japanese patients had been attributed to a lack of HLA diversity. However, the large proportion of Japanese patients with the A/A genotype offers a new explanation for the phenomenon.
The research findings were yesterday published in the New England Journal of Medicine.
In another article yesterday, experts from the University of Michigan Medical School said that, given the increased tolerance brought about by interleukin-10, future studies should look into the effect of increased interleukin-10 production on the eradication of residual cancer in patients after transplants.
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