作者
Sarah C. Sasson,Stephanie Slevin,Vincent Cheung,Isar Nassiri,Anna Olsson‐Brown,Eve Fryer,Ricardo C. Ferreira,Dominik Trzupek,Tarun Gupta,Lulia Al‐Hillawi,Mari-lenna Issaias,Alistair Easton,Leticia Campo,Michael Fitzpatrick,Joss Adams,Meenali M. Chitnis,Andrew Protheroe,Mark Tuthill,Nicholas Coupe,Alison Simmons,Miranda Payne,Mark R. Middleton,Simon Travis,Benjamin P. Fairfax,Paul Klenerman,Oliver Brain
摘要
The pathogenesis of immune checkpoint inhibitor (ICI)-colitis remains incompletely understood. We sought to identify key cellular drivers of ICI-colitis and their similarities to idiopathic ulcerative colitis, and to determine potential novel therapeutic targets.We used a cross-sectional approach to study patients with ICI-colitis, those receiving ICI without the development of colitis, idiopathic ulcerative colitis, and healthy controls. A subset of patients with ICI-colitis were studied longitudinally. We applied a range of methods, including multiparameter and spectral flow cytometry, spectral immunofluorescence microscopy, targeted gene panels, and bulk and single-cell RNA sequencing.We demonstrate CD8+ tissue resident memory T (TRM) cells are the dominant activated T cell subset in ICI-colitis. The pattern of gastrointestinal immunopathology is distinct from ulcerative colitis at both the immune and epithelial-signaling levels. CD8+ TRM cell activation correlates with clinical and endoscopic ICI-colitis severity. Single-cell RNA sequencing analysis confirms activated CD8+ TRM cells express high levels of transcripts for checkpoint inhibitors and interferon-gamma in ICI-colitis. We demonstrate similar findings in both anti-CTLA-4/PD-1 combination therapy and in anti-PD-1 inhibitor-associated colitis. On the basis of our data, we successfully targeted this pathway in a patient with refractory ICI-colitis, using the JAK inhibitor tofacitinib.Interferon gamma-producing CD8+ TRM cells are a pathological hallmark of ICI-colitis and a novel target for therapy.