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Omer OS, Hertweck A, Roberts LB, Lo JW, Clough JN, Jackson I, Pantazi ED, Irving PM, MacDonald TT, Pavlidis P, Jenner RG, Lord GM. Cyclin-dependent Kinase 9 as a Potential Target for Anti-TNF-resistant Inflammatory Bowel Disease. Cell Mol Gastroenterol Hepatol 2022; 14:625-641. [PMID: 35660024 PMCID: PMC9356186 DOI: 10.1016/j.jcmgh.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND & AIMS Resistance to single cytokine blockade, namely anti-tumor necrosis factor (TNF) therapy, is a growing concern for patients with inflammatory bowel disease (IBD). The transcription factor T-bet is a critical regulator of intestinal homeostasis, is genetically linked to mucosal inflammation and controls the expression of multiples genes such as the pro-inflammatory cytokines interferon (IFN)-γ and TNF. Inhibiting T-bet may therefore offer a more attractive prospect for treating IBD but remains challenging to target therapeutically. In this study, we evaluate the effect of targeting the transactivation function of T-bet using inhibitors of P-TEFb (CDK9-cyclin T), a transcriptional elongation factor downstream of T-bet. METHODS Using an adaptive immune-mediated colitis model, human colonic lymphocytes from patients with IBD and multiple large clinical datasets, we investigate the effect of cyclin-dependent kinase 9 (CDK9) inhibitors on cytokine production and gene expression in colonic CD4+ T cells and link these genetic modules to clinical response in patients with IBD. RESULTS Systemic CDK9 inhibition led to histological improvement of immune-mediated colitis and was associated with targeted suppression of colonic CD4+ T cell-derived IFN-γ and IL-17A. In colonic lymphocytes from patients with IBD, CDK9 inhibition potently repressed genes responsible for pro-inflammatory signalling, and in particular genes regulated by T-bet. Remarkably, CDK9 inhibition targeted genes that were highly expressed in anti-TNF resistant IBD and that predicted non-response to anti-TNF therapy. CONCLUSION Collectively, our findings reveal CDK9 as a potential target for anti-TNF-resistant IBD, which has the potential for rapid translation to the clinic.
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Affiliation(s)
- Omer S. Omer
- School of Immunology and Microbial Sciences, King's College London, London, UK,National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, UK
| | - Arnulf Hertweck
- UCL Cancer Institute and CRUK City of London Centre, University College London, London, UK
| | - Luke B. Roberts
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Jonathan W. Lo
- School of Immunology and Microbial Sciences, King's College London, London, UK,Division of Digestive Diseases, Faculty of Medicine, Imperial College, London, UK
| | - Jennie N. Clough
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, UK
| | - Ian Jackson
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Eirini D. Pantazi
- School of Immunology and Microbial Sciences, King's College London, London, UK,Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Peter M. Irving
- School of Immunology and Microbial Sciences, King's College London, London, UK,Inflammatory Bowel Disease Unit, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tom T. MacDonald
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Richard G. Jenner
- UCL Cancer Institute and CRUK City of London Centre, University College London, London, UK,Correspondence Address correspondence to: Professor Richard G. Jenner, UCL Cancer Institute, University College London, London, WC1E 6DD, UK.
| | - Graham M. Lord
- School of Immunology and Microbial Sciences, King's College London, London, UK,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK,Professor Graham M. Lord, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.
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2
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Goldberg R, Clough JN, Roberts LB, Sanchez J, Kordasti S, Petrov N, Hertweck A, Lorenc A, Jackson I, Tasker S, Appios A, Omer O, Parkes M, Prescott N, Jenner RG, Irving PM, Lord GM. A Crohn's Disease-associated IL2RA Enhancer Variant Determines the Balance of T Cell Immunity by Regulating Responsiveness to IL-2 Signalling. J Crohns Colitis 2021; 15:2054-2065. [PMID: 34120187 PMCID: PMC8684452 DOI: 10.1093/ecco-jcc/jjab103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Differential responsiveness to interleukin [IL]-2 between effector CD4+ T cells [Teff] and regulatory T cells [Treg] is a fundamental mechanism of immunoregulation. The single nucleotide polymorphism [SNP] rs61839660, located within IL2RA [CD25], has been associated with the development of Crohn's disease [CD]. We sought to identify the T cell immune phenotype of IBD patients who carry this SNP. METHODS Teff and Treg were isolated from individuals homozygous [TT], heterozygous [CT], or wild-type [CC] for the minor allele at rs61839660, and used for phenotyping [flow cytometry, Cytometry Time Of Flight] functional assays or T cell receptor [TCR] sequencing. Phosphorylation of signal transducer and activator of transcription 5 [STAT5] was assessed in response to IL-2, IL-7, and in the presence of basiliximab, a monoclonal antibody directed against CD25. Teff pro-inflammatory cytokine expression levels were assessed by reverse transcription quantitative polymerase chain reaction after IL-2 and/or TCR stimulation. RESULTS Presence of the minor T allele enhances CD25 expression, leading to increased STAT5 phosphorylation and pro-inflammatory cytokine transcript expression by Teff in response to IL-2 stimulation in vitro. Teff from TT individuals demonstrate a more activated gut homing phenotype. TCR sequencing analysis suggests that TT patients may have a reduced clonal capacity to mount an optimal regulatory T cell response. CONCLUSIONS rs61839660 regulates the responsiveness of T cells to IL-2 signalling by modulating CD25 expression. As low-dose IL-2 is being trialled as a selective Treg modulator in CD, these findings highlight the potential for adverse effects in patients with this genotype.
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Affiliation(s)
- Rimma Goldberg
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
| | - Jennie N Clough
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- IBD Unit, Gastroenterology Department, Guy’s and St Thomas’ NHS Trust, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
| | - Luke B Roberts
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
| | - Jenifer Sanchez
- School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Shahram Kordasti
- CRUK-KHP Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Nedyalko Petrov
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
| | | | - Anna Lorenc
- School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Ian Jackson
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
| | - Scott Tasker
- School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Anna Appios
- School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Omer Omer
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- IBD Unit, Gastroenterology Department, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Miles Parkes
- Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Natalie Prescott
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
- Medical and Molecular Genetics, Kings College London, London, UK
| | | | - Peter M Irving
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- IBD Unit, Gastroenterology Department, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Graham M Lord
- School of Immunology and Microbial Sciences, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Trust and King’s College London, London, UK
- Faculty of Biology, Medicine and Health, University of Manchester, UK
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3
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Tavabie OD, Clough JN, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston SL, DeMartino S, Gill US, Hayee B, Joshi D. Reduced survival after upper gastrointestinal bleed endoscopy in the COVID-19 era is a secondary effect of the response to the global pandemic: a retrospective cohort study. Frontline Gastroenterol 2020; 12:279-287. [PMID: 34249312 PMCID: PMC8231434 DOI: 10.1136/flgastro-2020-101592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has placed increased strain on healthcare systems worldwide with enormous reorganisation undertaken to support 'COVID-centric' services. Non-COVID-19 admissions reduced secondary to public health measures to halt viral transmission. We aimed to understand the impact of the response to COVID-19 on the outcomes of upper gastrointestinal (UGI) bleeds. DESIGN/METHODS A retrospective observational multicentre study comparing outcomes following endoscopy for UGI bleeds from 24 March 2020 to 20 April 2020 to the corresponding dates in 2019. The primary outcome was in-hospital survival at 30 days with secondary outcomes of major rebleeding within 30 days postprocedure and intervention at the time of endoscopy. RESULTS 224 endoscopies for 203 patients with UGI bleeds were included within this study. 19 patients were diagnosed with COVID-19. There was a 44.4% reduction in the number of procedures performed between 2019 and 2020. Endoscopies performed for UGI bleeds in the COVID-19 era were associated with an adjusted reduced 30-day survival (OR 0.25, 95% CI 0.08-0.67). There was no increased risk of major rebleeding or interventions during this era. Patients with COVID-19 did not have reduced survival or increased complication rates. CONCLUSION Endoscopy for UGI bleeds in the COVID-19 era is associated with reduced survival. No clear cause has been identified but we suspect that this is a secondary effect of the response to the COVID-19 pandemic. Urgent work is required to encourage the public to seek medical help if required and to optimise patient pathways to ensure that the best possible care is provided.
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Affiliation(s)
- Oliver D Tavabie
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | - Jennie N Clough
- Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan Blackwell
- Department of Gastroenterology, St George’s Hospitals NHS Foundation Trust, London, UK
| | - Maria Bashyam
- The Liver Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, London, UK
| | - Harry Martin
- Pancreaticobiliary Medicine Unit, UCLH, London, London, UK
| | - Anet Soubieres
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, London, UK
| | - Natalie Direkze
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, London, UK
| | - David Graham
- Department of Gastroenterology, UCLH, London, London, UK
| | - Christopher Groves
- Department of Gastroenterology, St George’s Hospitals NHS Foundation Trust, London, UK
| | - Sean L Preston
- Department of Gastroenterology, Royal London Hospital, London, London, UK
| | - Sabina DeMartino
- Department of Gastroenterology, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
| | - Upkar S Gill
- Department of Gastroenterology, Royal London Hospital, London, London, UK,Barts Liver Centre, Immunobiology, Barts and the London School of Medicine and Dentistry, QMUL, London, London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
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4
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Clough JN, Hill KL, Duff A, Sharma E, Ray S, Mawdsley JE, Anderson S, Irving PM, Samaan MA. Managing an IBD Infusion Unit During the COVID-19 Pandemic: Service Modifications and the Patient Perspective. Inflamm Bowel Dis 2020; 26:e125-e126. [PMID: 32592475 PMCID: PMC7337736 DOI: 10.1093/ibd/izaa171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jennie N Clough
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, Guy’s Hospital, London, United Kingdom,Address correspondence to: Jennie N. Clough, Gastroenterology Department, St. Thomas’s Hospital, London, SE1 7EH, United Kingdom ()
| | - Katie L Hill
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
| | - Alexa Duff
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
| | - Esha Sharma
- Pharmacy Department, Guy’s and St. Thomas’s NHS Foundation Trust, London, United Kingdom
| | - Shuvra Ray
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
| | - Joel E Mawdsley
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
| | - Simon Anderson
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
| | - Peter M Irving
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom,School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Mark A Samaan
- Gastroenterology Department, Guy’s and St. Thomas’s National Health service (NHS) Foundation Trust, London, United Kingdom
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5
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Abstract
The prevalence of IBD is rising in the Western world. Despite an increasing repertoire of therapeutic targets, a significant proportion of patients suffer chronic morbidity. Studies in mice and humans have highlighted the critical role of regulatory T cells in immune homeostasis, with defects in number and suppressive function of regulatory T cells seen in patients with Crohn's disease. We review the function of regulatory T cells and the pathways by which they exert immune tolerance in the intestinal mucosa. We explore the principles and challenges of manufacturing a cell therapy, and discuss clinical trial evidence to date for their safety and efficacy in human disease, with particular focus on the development of a regulatory T-cell therapy for Crohn's disease.
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Affiliation(s)
- Jennie N Clough
- School of Immunology and Microbial Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and Saint Thomas' NHS Foundation Trust and King's College, London, UK
| | - Omer S Omer
- School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Scott Tasker
- Division of Transplantation Immunology and Mucosal Biology, King's College London, London, UK
| | - Graham M Lord
- School of Immunology and Microbial Sciences, King's College London, London, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter M Irving
- School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
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6
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Tavabie O, Clough JN, Blackwell J, Bashyam M, Martin H, Soubieres A, Direkze N, Graham D, Groves C, Preston SL, DeMartino S, Gill US, Hayee B, Joshi D. Reduced Survival After Gastrointestinal Bleed Endoscopy in the COVID-19 Era Is a Secondary Effect of the Global Pandemic: A Retrospective Cohort Study. SSRN Journal 2020. [DOI: 10.2139/ssrn.3627299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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