Gut-associated lymphoid tissue attrition associates with response to anti-α4β7 therapy in ulcerative colitis

Sci Immunol. 2024 Apr 19;9(94):eadg7549. doi: 10.1126/sciimmunol.adg7549. Epub 2024 Apr 19.

Abstract

Vedolizumab (VDZ) is a first-line treatment in ulcerative colitis (UC) that targets the α4β7- mucosal vascular addressin cell adhesion molecule 1 (MAdCAM-1) axis. To determine the mechanisms of action of VDZ, we examined five distinct cohorts of patients with UC. A decrease in naïve B and T cells in the intestines and gut-homing (β7+) plasmablasts in circulation of VDZ-treated patients suggested that VDZ targets gut-associated lymphoid tissue (GALT). Anti-α4β7 blockade in wild-type and photoconvertible (KikGR) mice confirmed a loss of GALT size and cellularity because of impaired cellular entry. In VDZ-treated patients with UC, treatment responders demonstrated reduced intestinal lymphoid aggregate size and follicle organization and a reduction of β7+IgG+ plasmablasts in circulation, as well as IgG+ plasma cells and FcγR-dependent signaling in the intestine. GALT targeting represents a previously unappreciated mechanism of action of α4β7-targeted therapies, with major implications for this therapeutic paradigm in UC.

MeSH terms

  • Animals
  • Colitis, Ulcerative* / drug therapy
  • Humans
  • Immunoglobulin G / therapeutic use
  • Integrins
  • Intestinal Mucosa
  • Mice
  • Peyer's Patches

Substances

  • Integrins
  • Immunoglobulin G