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Microbiota-specific T cells were found to augment GVHD lethality by targeting microbial antigens presented by gastrointestinal epithelium during an alloreactive response. Thus, the microbiota serves as a source of cognate antigens that contribute to clonotypic T cell expansion and the induction of GVHD, independent of donor-recipient genetics.
Recent studies since the early 2010s have highlighted the significant role of gut microbiota in GVHD: