Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Division of Gastroenterology, Akashi Medical Center, Akashi, Japan.
Sci Rep. 2023 Nov 20;13(1):20262. doi: 10.1038/s41598-023-47618-3.
Not all patients with ulcerative colitis (UC) respond initially to treatment with biologic agents, and predicting their efficacy prior to treatment is difficult. Vedolizumab, a humanized monoclonal antibody against alpha 4 beta 7 (α4β7) integrin, suppresses immune cell migration by blocking the interaction between α4β7 integrin and mucosal addressin cell adhesion molecule 1. Reports about histological features that predict vedolizumab efficacy are scarce. So, we examined the association between histological features and vedolizumab efficacy. This was a multicenter, retrospective study of patients with UC treated with vedolizumab. Biopsy specimens taken from the colonic mucosa prior to vedolizumab induction were used, and the areas positively stained for CD4, CD68, and CD45 were calculated. Clinical and histological features were compared between those with and without remission at week 22, and the factors associated with clinical outcomes were identified. We enrolled 42 patients. Patients with a high CD4+ infiltration showed a better response to vedolizumab [odds ratio (OR) = 1.44, P = 0.014]. The concomitant use of corticosteroids and high Mayo scores had a negative association with the vedolizumab response (OR = 0.11, P = 0.008 and OR = 0.50, P = 0.009, respectively). Histological evaluation for CD4+ cell infiltration may be helpful in selecting patients who can benefit from vedolizumab.
并非所有溃疡性结肠炎 (UC) 患者最初对生物制剂治疗有反应，并且在治疗前预测其疗效较为困难。Vedolizumab 是一种针对 α4β7（α4β7）整合素的人源化单克隆抗体，通过阻断 α4β7 整合素与黏膜地址素细胞黏附分子 1 之间的相互作用来抑制免疫细胞迁移。关于预测 vedolizumab 疗效的组织学特征的报告很少。因此，我们研究了组织学特征与 vedolizumab 疗效之间的关系。这是一项多中心、回顾性研究，纳入了接受 vedolizumab 治疗的 UC 患者。使用 vedolizumab 诱导前取自结肠黏膜的活检标本，并计算 CD4、CD68 和 CD45 阳性染色的面积。比较了第 22 周时缓解和未缓解患者的临床和组织学特征，并确定了与临床结局相关的因素。我们共纳入了 42 例患者。CD4+浸润程度高的患者对 vedolizumab 的反应更好[优势比（OR）=1.44，P=0.014]。皮质类固醇的同时使用和高 Mayo 评分与 vedolizumab 反应呈负相关（OR=0.11，P=0.008 和 OR=0.50，P=0.009）。CD4+细胞浸润的组织学评估可能有助于选择能从 vedolizumab 中获益的患者。
