Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
J Transl Med. 2023 Jul 13;21(1):466. doi: 10.1186/s12967-023-04326-w.
BACKGROUND AND AIMS: We sought to identify novel molecular subtypes of ulcerative colitis (UC) based on large-scale cohorts and establish a clinically applicable subtyping system for the precision treatment of the disease. METHODS: Eight microarray profiles containing colon samples from 357 patients were utilized. Expression heterogeneity was screened out and stable subtypes were identified among UC patients. Immune infiltration pattern and biological agent response were compared among subtypes to assess the value in guiding treatment. The relationship between PRLR and TNFSF13B genes with the highest predictive value was further validated by functional experiments. RESULTS: Three stable molecular subtypes were successfully identified. Immune cell infiltration analysis defined three subtypes as innate immune activated UC (IIA), whole immune activated UC (WIA), and immune homeostasis like UC (IHL). Notably, the response rate towards biological agents (infliximab/vedolizumab) in WIA patients was the lowest (less than 10%), while the response rate in IHL patients was the highest, ranging from 42 to 60%. Among the featured genes of subtypes, the ratio of PRLR to TNFSF13B could effectively screen for IHL UC subtype suitable for biological agent therapies (Area under curve: 0.961-0.986). Furthermore, we demonstrated that PRLR expressed in epithelial cells could inhibit the expression of TNFSF13B in monocyte-derived macrophages through the CXCL1-NF-κB pathway. CONCLUSIONS: We identified three stable UC subtypes with a heterogeneous immune pattern and different response rates towards biological agents for the first time. We also established a precise molecular subtyping system and classifier to predict clinical drug response and provide individualized treatment strategies for UC patients.
背景与目的:我们试图基于大规模队列确定溃疡性结肠炎(UC)的新型分子亚型,并建立一种用于疾病精准治疗的临床适用的分型系统。
方法:利用包含 357 例患者结肠样本的 8 个微阵列图谱,筛选出表达异质性并在 UC 患者中确定稳定的亚型。比较各亚型之间的免疫浸润模式和生物制剂反应,以评估其在指导治疗中的价值。通过功能实验进一步验证预测价值最高的 PRLR 和 TNFSF13B 基因之间的关系。
结果:成功鉴定出三种稳定的分子亚型。免疫细胞浸润分析将三种亚型定义为固有免疫激活型 UC(IIA)、全免疫激活型 UC(WIA)和免疫稳态样 UC(IHL)。值得注意的是,WIA 患者对生物制剂(英夫利昔单抗/vedolizumab)的反应率最低(不到 10%),而 IHL 患者的反应率最高,范围为 42%至 60%。在各亚型的特征基因中,PRLR 与 TNFSF13B 的比值可有效筛选出适合生物制剂治疗的 IHL UC 亚型(曲线下面积:0.961-0.986)。此外,我们证明上皮细胞中表达的 PRLR 通过 CXCL1-NF-κB 通路抑制单核细胞衍生巨噬细胞中 TNFSF13B 的表达。
结论:我们首次确定了三种具有不同免疫模式和对生物制剂反应率的稳定 UC 亚型。我们还建立了一个精确的分子分型系统和分类器,以预测临床药物反应并为 UC 患者提供个体化的治疗策略。
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