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Ustekinumab Resistance in Individuals with Ulcerative Colitis is Associated with an Alteration of a Subset of Pro-inflammatory Mucosal Regulatory T cells

ABSTRACT: Background & Aims: Ustekinumab is a monoclonal antibody therapy targeting interleukin 12 and 23 for the treatment of inflammatory bowel diseases, including ulcerative colitis (UC). While these pathways remain quite attractive for UC therapy, response to ustekinumab can be variable. There is an urgent need to better understand the underlying mucosal immune alterations associated with treatment to guide therapy decisions. This study aims to examine the mucosal immune signatures in individuals with UC with variable treatment response to ustekinumab. Methods: Sigmoid colon tissue from individuals treated with ustekinumab were analyzed using a multi-modal approach. Single-cell RNA and T cell receptor sequencing was performed on mucosal biopsies. In a subset of these patents, multiparameter flow cytometry and spatial transcriptomics was also completed on matched pre- and post-treatment tissue samples. Key findings were also validated on a larger cohort using immunohistochemistry. Results: Ustekinumab significantly altered the frequency and phenotype of mucosal regulatory T cells (Tregs). Non-responders to ustekinumab had a higher frequency of Tregs that expressed OX40 and GITR, which is associated with decreased suppressive abilities. In contrast, responders had Tregs with elevated GPR15 and reduced expression of the kinase PIM2, which can alter Treg stability and function. Additionally, Th17 cells in non-responders demonstrated an enhanced pro-inflammatory gene expression profile. Conclusion: Non-response to ustekinumab in UC is linked to a mucosal immune environment enriched with pro-inflammatory T cell phenotypes and impaired regulatory T cell function. These findings suggest that Tregs are both targets and potential biomarkers of ustekinumab response, with their phenotypic and transcriptional features providing insight into mechanisms of therapeutic resistance.

ORGANISM(S): Homo sapiens

PROVIDER: GSE327665 | GEO | 2026/04/17

REPOSITORIES: GEO

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Project description:The objective of this study was to identify pre-treatment colonic gene expression patterns in patients with inflammatory bowel disease (Ulcerative Colitis and colonic Crohn’s disease) that are predictive of a good versus poor response to treatment with the bioloic anti-TNFa. By identifying key pathways that are altered in responders versus non-responders we also aimed to propose novel targets for therapy. Pre-treatment colonic endoscopic biopsies were collected in RNAlater from 22 patients (14 CD and 8 UC) who were starting anti-TNFa therapy. RNA was extracted using RNeasy columns (Qiagen) and quantified by Qubit (Life Technologies). 0.5ng RNA was used to prepare uniquely indexed cDNA QIAseq UPX 3’ Transcriptome libraries according to manufacturer’s instructions (Qiagen). Libraries were quantified and quality-controlled using the QIAseq Library Quant Assay Kit and tapestation analysis and sequenced on the Miseq and Nextseq Illumina platforms using the illumina sequencing primer and PhiX 15% to a depth of 1-3milion reads/sample. Read numbers were set as 101 bp (R1) x 51 bp (R2). Fastq files were obtained through BaseSpace and reads de-multiplexed, aligned to human genome GRCh38, quantified and normalised by the TPM method using the CLC Genomics Workbench (Qiagen). The following differential expression procedure was performed for participants classified as responders, partial responders or non-responders according to their endoscopic presentation 12 weeks after therapy. For UC patients the Mayo score was used: Responders Mayo= 0, Partial responders 1<= Mayo <3 and Non Responders Mayo >=3. For CD patients % reduction in the SES-CD score was used: Responders >=50% of SES-CD, Partial responders 50%<SES-CD<75%, Non responders SES-CD > 75%. Normalised values were log-transformed with a pseudocount of 1 added. Transcripts with < 1 transformed count in any sample were excluded from further analysis, as were transcripts with low variance (defined as less than 10% unique counts across both conditions and greater than a 19:1 ratio of the most frequent count to the second most frequent across both conditions). Differential expression analysis between conditions was conducted with the limma package. Library size was estimated using reduced maximum likelihood estimator with 500 iterations. Initial fitting was performed using a robust M-estimation, and moderated test statistics computed by empirical Bayes. A FDR corrected p value <0.05 was considered and filtered for further downstream data analysis. Partial least squares discriminant analysis (PLS-DA) modelling was performed on these genes to calculate their variable Importance in Projection (VIP) score. To understand the biological significance and pathways represented in the DEGS, we also performed enrichment analysis using the DAVID Gene Functional Classification Tool (REF I,II). Finally, strongest indicators of response were predicted by Random Forest Area Under the Curve (AUC) analysis.

Project description:Background & Aims: Genome-wide gene expression (GWGE) profiles of mucosal colonic biopsies have suggested the existence of a continuous inflammatory state in quiescent ulcerative colitis (UC). The aim of this study was to use DNA microarray-based GWGE profiling of mucosal colonic biopsies and isolated colonocytes from UC patients and controls in order to identify the cell types responsible for the continuous inflammatory state. Methods: Adjacent mucosal colonic biopsies were obtained endoscopically from the descending colon in patients with active UC (n=8), quiescent UC (n=9), and with irritable bowel syndrome (controls, n=10). After isolation of colonocytes and subsequent extraction of total RNA, GWGE data were acquired using Human Genome U133 Plus 2.0 GeneChip Array (Affymetrix, Santa Clara, CA). Data analysis was carried out by principal component analysis and projection to latent structure-discriminant analysis using the SIMCA-P11 software (Umetrics, Umeå, Sweden). Results: A clear separation between active UC, quiescent UC and control biopsies were found, whereas the model for the colonocytes was unable to distinguish between quiescent UC and controls. The differentiation between quiescent UC and control biopsies was governed by unique profiles containing gene expressions with significant fold changes. These primarily belonged to the family of homeostatic chemokines revealing a plausible explanation to the abnormal regulated innate immune response seen in patients with UC. Conclusion: This study has demonstrated the presence of a continuous inflammatory state in quiescent UC, which seems to reflect an altered gene expression profile of lamina propria cells. Keywords: Colonocytes, continuous inflammation, mucosal colonic biopsies, gene expression profiles Adjacent mucosal colonic biopsies were attained endoscopically from the descending colon in patients with active UC (n=8), quiescent UC (n=9), and in controls (n=10). After extraction of total RNA, genome-wide gene expression data were acquired using Human Genome U133 Plus 2.0 GeneChip Array (Affymetrix, Santa Clara, CA). Amplification was required to obtain sufficient amounts of labelled complementary RNA (cRNA) target for analysis with arrays. Data analysis was carried out by principal component analysis and projection to latent structure-discriminant analysis using the SIMCA-P11 software (Umetrics, Umeå, Sweden).

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Ustekinumab Resistance in Individuals with Ulcerative Colitis is Associated with an Alteration of a Subset of Pro-inflammatory Mucosal Regulatory T cells

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