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Quénéhervé L, Trang-Poisson C, Fantou A, Flamant M, Durand T, Bouguen G, Bregeon J, Oullier T, Amil M, Dewitte M, Bardot S, Blandin S, Braudeau C, Vibet MA, Josien R, Neunlist M, Bourreille A. Confocal laser endomicroscopy as predictive biomarker of clinical and endoscopic efficacy of vedolizumab in ulcerative colitis: The DETECT study. PLoS One 2024; 19:e0298313. [PMID: 38564601 PMCID: PMC10986992 DOI: 10.1371/journal.pone.0298313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS In patients with ulcerative colitis (UC), no biomarker is available to help the physician to choose the most suitable biotherapy. The primary objective of this pilot study was to assess the feasibility of identification of α4β7- and TNF-expressing cells, to predict the response to vedolizumab using confocal laser endoscopy (CLE). METHODS Patients with moderate-to-severe UC, naïve of biotherapy, received vedolizumab. Clinical evaluation was performed at each infusion. Endoscopic evaluation was performed before inclusion and at week 22. Fresh colonic biopsies were stained using FITC-labelled vedolizumab and Alexa fluor-labelled adalimumab and ex vivo dual-band CLE images were acquired. Blood samples were collected to measure trough concentrations of vedolizumab and to determine absolute counts of T and B cells subpopulations, NK cells and monocytes. RESULTS Nineteen patients were enrolled in the study and received at least one dose of vedolizumab. Clinical remission and endoscopic improvement were observed in 58% of whom 5 patients (45%) had an endoscopic subscore of 0. In terms of clinical response and remission, endoscopic improvement and histologic response, FITC-conjugated vedolizumab staining tended to be higher in responder patients compared to non-responders at week 22. A threshold value of 6 positive FITC-vedolizumab staining areas detected by CLE seemed informative to discriminate the responders and non-responders. The results were similar in terms of clinical remission and endoscopic improvement with a sensitivity of 78% and a specificity of 85% (p = 0.05). Trough concentrations and blood immune cells were not associated with responses to vedolizumab. CONCLUSION This pilot study demonstrate that dual-band CLE is feasible to detect α4β7- and TNF-expressing cells. Positive α4β7 staining seems to be associated with clinical and endoscopic remission in UC patients treated by anti-α4β7-integrin, subject to validation by larger-scale studies. Clinical-trial.gov: NCT02878083.
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Affiliation(s)
- Lucille Quénéhervé
- Department of Gastroenterology, University Hospital of Brest, Brest, France
| | - Caroline Trang-Poisson
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Aurélie Fantou
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Mathurin Flamant
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Tony Durand
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Guillaume Bouguen
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Jérémy Bregeon
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Thibauld Oullier
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Morgane Amil
- CHD La Roche-Sur-Yon, Hepato-gastroentérologie, La Roche-Sur-Yon, France
| | - Marie Dewitte
- Université de Rennes, CHU Rennes, Institut NUMECAN (Nutrition Metabolism and Cancer), Hepato-Gastroenterologie, Inserm CIC1414, Rennes, France
| | - Stéphanie Bardot
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
| | - Stéphanie Blandin
- Nantes Université, UMS BioCore, Inserm US16—UAR CNRS 3556, Nantes, France
| | - Cécile Braudeau
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Marie-Anne Vibet
- CHU Nantes, Methodology and Biostatistics Department, Direction de la Recherche Clinique et de l’Innovation, Nantes, France
| | - Régis Josien
- Nantes Université, CHU Nantes, CRT2I, UMR Inserm 1064, Nantes, France
| | - Michel Neunlist
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), UMR Inserm 1235 TENS, Nantes, France
| | - Arnaud Bourreille
- Nantes Université, CHU Nantes, Institut des Maladies de l’Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, Nantes, France
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