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Survival signal REG3&agr; prevents crypt apoptosis to control acute gastrointestinal graft-versus-host disease

Graft-versus-host disease (GVHD) in the gastrointestinal (GI) tract remains the major cause of morbidity and nonrelapse mortality after BM transplantation (BMT). The Paneth cell protein regenerating islet-derived 3&agr; (REG3&agr;) is a biomarker specific for GI GVHD. REG3&agr; serum levels rose in the systematic circulation as GVHD progressively destroyed Paneth cells and reduced GI epithelial barrier function. Paradoxically, GVHD suppressed intestinal REG3&ggr; (the mouse homolog of human REG3&agr;), and the absence of REG3&ggr; in BMT recipients intensified GVHD but did not change the composition of the microbiome. IL-22 administration restored REG3&ggr; production and prevented apoptosis of both intestinal stem cells (ISCs) and Paneth cells, but this protection was completely abrogated in Reg3g−/− mice. In vitro, addition of REG3&agr; reduced the apoptosis of colonic cell lines. Strategies that increase intestinal REG3&agr;/&ggr; to promote crypt regeneration may offer a novel, nonimmunosuppressive approach for GVHD and perhaps for other diseases involving the ISC niche, such as inflammatory bowel disease.