Extrafollicular CD4 + T-B interactions are sufficient for inducing autoimmune-like chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is an autoimmune-like syndrome mediated by pathogenic CD4 ⁺ T and B cells, but the function of extrafollicular and germinal center CD4 ⁺ T and B interactions in cGVHD pathogenesis remains largely unknown. Here we show that extrafollicular CD4 ⁺ T and B interactions are sufficient for inducing cGVHD, while germinal center formation is dispensable. The pathogenesis of cGVHD is associated with the expansion of extrafollicular CD44 ^hi CD62 ^lo PSGL-1 ^lo CD4 ⁺ (PSGL-1 ^lo CD4 ⁺ ) T cells. These cells express high levels of ICOS, and the blockade of ICOS/ICOSL interaction prevents their expansion and ameliorates cGVHD. Expansion of PSGL-1 ^lo CD4 ⁺ T cells is also prevented by BCL6 or Stat3 deficiency in donor CD4 ⁺ T cells, with the induction of cGVHD ameliorated by BCL6 deficiency and completely suppressed by Stat3 deficiency in donor CD4 ⁺ T cells. These results support that Stat3- and BCL6-dependent extrafollicular CD4 ⁺ T and B interactions play critical functions in the pathogenesis of cGVHD.Chronic graft-versus-host disease (cGVHD) is mediated by specific CD4 and B cells, but the relative contribution of extrafollicular and germinal centre (GC) T-B interaction is unclear. Here the authors show that the extrafollicular expansion of a specific CD4 T subset is sufficient for inducing cGVHD while GC is dispensable.