Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, USA.
Department of Pathology, University of Chicago, Chicago, IL, USA.
J Crohns Colitis. 2024 Apr 23;18(4):638-641. doi: 10.1093/ecco-jcc/jjad174.
Ozanimod regulates lymphocyte egress from the spleen and lymph nodes into the systemic circulation. The histological changes which occur in the lymph nodes of patients on ozanimod is unknown.
This retrospective study included patients with ulcerative colitis [UC] undergoing total colectomy for treatment-refractory disease who received ozanimod, and a cohort of patients with UC undergoing colectomy who did not have ozanimod exposure. Histology of the lymph nodes from the mesentery of colectomy specimens was reviewed and multiple features were scored by experienced pathologists.
Six [13%] ozanimod-treated patients with UC required surgery for treatment-refractory disease. Colectomy specimen data were available for five patients [one patient had surgery at an outside centre]. Lymph node specimens from six control patients with UC who had colectomy were examined. Histological examination of lymph nodes showed that patients treated with ozanimod had significantly greater extent of dilated sinuses [p = 0.03] and greater degrees of sinus histiocytosis [p = 0.03] compared with control patients. In addition, there was a trend towards more Castleman-like angiotrophic hyperplasia, plasma cell infiltration, and subcortical interfollicular expansion in ozanimod-treated patients.
This study identifies unique histological changes in the lymph nodes of patients with UC treated with ozanimod. The presence of sinus histiocytosis and dilated sinuses is in keeping with the known mechanism of action of ozanimod, and suggests that blocking lymphocyte egression from lymph nodes was insufficient to ameliorate disease severity in these patients. The possibility of Castleman-like features, identified in several of the cases, needs to be further investigated.
奥扎莫德可调节淋巴细胞从脾脏和淋巴结逸出到全身循环。接受奥扎莫德治疗的患者的淋巴结中发生的组织学变化尚不清楚。
本回顾性研究纳入了因难治性疾病而接受全结肠切除术的溃疡性结肠炎[UC]患者，这些患者接受了奥扎莫德治疗，以及一组未接受奥扎莫德暴露的接受结肠切除术的 UC 患者。对结肠切除标本肠系膜淋巴结的组织学进行了回顾，并由经验丰富的病理学家对多个特征进行了评分。
六名[13%]接受奥扎莫德治疗的 UC 患者因难治性疾病需要手术。五名患者[一名患者在外部中心接受手术]可获得结肠切除术标本数据。检查了六名接受结肠切除术的 UC 对照患者的淋巴结标本。淋巴结组织学检查显示，与对照患者相比，接受奥扎莫德治疗的患者具有明显更大程度的扩张窦[p=0.03]和更大程度的窦组织细胞增生[p=0.03]。此外，奥扎莫德治疗患者中存在倾向于更多的血管滤泡样超增生、浆细胞浸润和皮质下滤泡间扩张的趋势。
本研究确定了接受奥扎莫德治疗的 UC 患者淋巴结的独特组织学变化。窦组织细胞增生和窦扩张的存在与奥扎莫德的已知作用机制一致，并表明阻止淋巴细胞从淋巴结逸出不足以改善这些患者的疾病严重程度。在几个病例中发现的类似于卡斯尔曼的特征的存在需要进一步研究。
