Letter: choosing between ustekinumab and vedolizumab in anti‐TNF refractory Crohn’s disease—the devil is in the detail

Srinivasan, Ashish; Cruz, Peter P De; Langenberg, Daniel R. van

doi:10.1111/apt.15862

Cited by 2 publications

(2 citation statements)

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“…The above combination of evidence suggests that the modulation of the FOXO pathway could be part of a molecular phenotype associated with the pathogenesis at the primary disease site(s), although further independent validation in larger cohorts is warranted. Although it is not clear if and how the ileal phenotype affects the potential relationship between IBD disease burden and the FOXO3 mutation, the refractory nature of ileal CD58 as manifested across multiple clinical trials and additional meta-analysis59 60 suggests that novel targets are indeed required. FOXO pathway members ( BCL6, CDKN1A, BTG1, GADD45A, KLF4 ) which are upregulated in ileal CD patients, could potentially fill this therapeutic gap (table 2).…”

Section: Discussionmentioning

confidence: 99%

Distinct transcriptional signatures in purified circulating immune cells drive heterogeneity in disease location in IBD

Verstockt

Cremer

et al. 2023

BMJ Open Gastroenterol

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ObjectiveTo infer potential mechanisms driving disease subtypes among patients with inflammatory bowel disease (IBD), we profiled the transcriptome of purified circulating monocytes and CD4 T-cells.DesignRNA extracted from purified monocytes and CD4 T-cells derived from the peripheral blood of 125 endoscopically active patients with IBD was sequenced using Illumina HiSeq 4000NGS. We used complementary supervised and unsupervised analytical methods to infer gene expression signatures associated with demographic/clinical features. Expression differences and specificity were validated by comparison with publicly available single cell datasets, tissue-specific expression and meta-analyses. Drug target information, druggability and adverse reaction records were used to prioritise disease subtype-specific therapeutic targets.ResultsUnsupervised/supervised methods identified significant differences in the expression profiles of CD4 T-cells between patients with ileal Crohn’s disease (CD) and ulcerative colitis (UC). Following a pathway-based classification (Area Under Receiver Operating Characteristic - AUROC=86%) between ileal-CD and UC patients, we identified MAPK and FOXO pathways to be downregulated in UC. Coexpression module/regulatory network analysis using systems-biology approaches revealed mediatory core transcription factors. We independently confirmed that a subset of the disease location-associated signature is characterised by T-cell-specific and location-specific expression. Integration of drug-target information resulted in the discovery of several new (BCL6,GPR183,TNFAIP3) and repurposable drug targets (TUBB2A,PRKCQ) for ileal CD as well as novel targets (NAPEPLD,SLC35A1) for UC.ConclusionsTranscriptomic profiling of circulating CD4 T-cells in patients with IBD demonstrated marked molecular differences between the IBD-spectrum extremities (UC and predominantly ileal CD, sandwiching colonic CD), which could help in prioritising particular drug targets for IBD subtypes.

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