Interleukin‐17 Inhibition in Spondyloarthritis Is Associated With Subclinical Gut Microbiome Perturbations and a Distinctive Interleukin‐25–Driven Intestinal Inflammation

Objective To characterize the ecological effects of biologic therapies on the gut bacterial and fungal microbiome in psoriatic arthritis (PsA)/spondyloarthritis (SpA) patients. Methods Fecal samples from PsA/SpA patients pre‐ and posttreatment with tumor necrosis factor inhibitors (TNFi; n = 15) or...

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Veröffentlicht in:Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2020-04, Vol.72 (4), p.645-657
Hauptverfasser: Manasson, Julia, Wallach, David S., Guggino, Giuliana, Stapylton, Matthew, Badri, Michelle H., Solomon, Gary, Reddy, Soumya M., Coras, Roxana, Aksenov, Alexander A., Jones, Drew R., Girija, Parvathy V., Neimann, Andrea L., Heguy, Adriana, Segal, Leopoldo N., Dorrestein, Pieter C., Bonneau, Richard, Guma, Monica, Ciccia, Francesco, Ubeda, Carles, Clemente, Jose C., Scher, Jose U.
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container_end_page 657
container_issue 4
container_start_page 645
container_title Arthritis & rheumatology (Hoboken, N.J.)
container_volume 72
creator Manasson, Julia
Wallach, David S.
Guggino, Giuliana
Stapylton, Matthew
Badri, Michelle H.
Solomon, Gary
Reddy, Soumya M.
Coras, Roxana
Aksenov, Alexander A.
Jones, Drew R.
Girija, Parvathy V.
Neimann, Andrea L.
Heguy, Adriana
Segal, Leopoldo N.
Dorrestein, Pieter C.
Bonneau, Richard
Guma, Monica
Ciccia, Francesco
Ubeda, Carles
Clemente, Jose C.
Scher, Jose U.
description Objective To characterize the ecological effects of biologic therapies on the gut bacterial and fungal microbiome in psoriatic arthritis (PsA)/spondyloarthritis (SpA) patients. Methods Fecal samples from PsA/SpA patients pre‐ and posttreatment with tumor necrosis factor inhibitors (TNFi; n = 15) or an anti–interleukin‐17A monoclonal antibody inhibitor (IL‐17i; n = 14) underwent sequencing (16S ribosomal RNA, internal transcribed spacer and shotgun metagenomics) and computational microbiome analysis. Fecal levels of fatty acid metabolites and cytokines/proteins implicated in PsA/SpA pathogenesis or intestinal inflammation were correlated with sequence data. Additionally, ileal biopsies obtained from SpA patients who developed clinically overt Crohn's disease (CD) after treatment with IL‐17i (n = 5) were analyzed for expression of IL‐23/Th17–related cytokines, IL‐25/IL‐17E–producing cells, and type 2 innate lymphoid cells (ILC2s). Results There were significant shifts in abundance of specific taxa after treatment with IL‐17i compared to TNFi, particularly Clostridiales (P = 0.016) and Candida albicans (P = 0.041). These subclinical alterations correlated with changes in bacterial community co‐occurrence, metabolic pathways, IL‐23/Th17–related cytokines, and various fatty acids. Ileal biopsies showed that clinically overt CD was associated with expansion of IL‐25/IL‐17E–producing tuft cells and ILC2s (P < 0.05), compared to pre–IL‐17i treatment levels. Conclusion In a subgroup of SpA patients, the initiation of IL‐17A blockade correlated with features of subclinical gut inflammation and intestinal dysbiosis of certain bacterial and fungal taxa, most notably C albicans. Further, IL‐17i–related CD was associated with overexpression of IL‐25/IL‐17E–producing tuft cells and ILC2s. These results may help to explain the potential link between inhibition of a specific IL‐17 pathway and the (sub)clinical gut inflammation observed in SpA.
doi_str_mv 10.1002/art.41169
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Methods Fecal samples from PsA/SpA patients pre‐ and posttreatment with tumor necrosis factor inhibitors (TNFi; n = 15) or an anti–interleukin‐17A monoclonal antibody inhibitor (IL‐17i; n = 14) underwent sequencing (16S ribosomal RNA, internal transcribed spacer and shotgun metagenomics) and computational microbiome analysis. Fecal levels of fatty acid metabolites and cytokines/proteins implicated in PsA/SpA pathogenesis or intestinal inflammation were correlated with sequence data. Additionally, ileal biopsies obtained from SpA patients who developed clinically overt Crohn's disease (CD) after treatment with IL‐17i (n = 5) were analyzed for expression of IL‐23/Th17–related cytokines, IL‐25/IL‐17E–producing cells, and type 2 innate lymphoid cells (ILC2s). Results There were significant shifts in abundance of specific taxa after treatment with IL‐17i compared to TNFi, particularly Clostridiales (P = 0.016) and Candida albicans (P = 0.041). These subclinical alterations correlated with changes in bacterial community co‐occurrence, metabolic pathways, IL‐23/Th17–related cytokines, and various fatty acids. Ileal biopsies showed that clinically overt CD was associated with expansion of IL‐25/IL‐17E–producing tuft cells and ILC2s (P &lt; 0.05), compared to pre–IL‐17i treatment levels. Conclusion In a subgroup of SpA patients, the initiation of IL‐17A blockade correlated with features of subclinical gut inflammation and intestinal dysbiosis of certain bacterial and fungal taxa, most notably C albicans. Further, IL‐17i–related CD was associated with overexpression of IL‐25/IL‐17E–producing tuft cells and ILC2s. These results may help to explain the potential link between inhibition of a specific IL‐17 pathway and the (sub)clinical gut inflammation observed in SpA.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.41169</identifier><identifier>PMID: 31729183</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Antibodies, Monoclonal, Humanized - pharmacology ; Antibodies, Monoclonal, Humanized - therapeutic use ; Arthritis ; Arthritis, Psoriatic - drug therapy ; Arthritis, Psoriatic - metabolism ; Arthritis, Psoriatic - microbiology ; Bacteria ; Biological effects ; Biopsy ; Computer applications ; Correlation ; Crohn's disease ; Cytokines ; Digestive system ; Dysbacteriosis ; Ecological effects ; Fatty acids ; Female ; Fungi ; Gastrointestinal Microbiome - drug effects ; Gastrointestinal tract ; Gene sequencing ; Helper cells ; Humans ; Inflammation ; Inflammation - metabolism ; Inflammatory diseases ; Interleukin-17 - immunology ; Interleukins ; Intestinal microflora ; Intestinal Mucosa - metabolism ; Intestine ; Intestines - drug effects ; Intestines - microbiology ; Lymphocytes T ; Lymphoid cells ; Male ; Medical treatment ; Metabolic pathways ; Metabolites ; Metagenomics ; Microbiomes ; Microbiota ; Middle Aged ; Monoclonal antibodies ; Pathogenesis ; Patients ; Psoriatic arthritis ; Rheumatic diseases ; rRNA 16S ; Spondylarthritis - drug therapy ; Spondylarthritis - metabolism ; Spondylarthritis - microbiology ; Subgroups ; Tumor Necrosis Factor Inhibitors - pharmacology ; Tumor Necrosis Factor Inhibitors - therapeutic use</subject><ispartof>Arthritis &amp; rheumatology (Hoboken, N.J.), 2020-04, Vol.72 (4), p.645-657</ispartof><rights>2019, American College of Rheumatology</rights><rights>2019, American College of Rheumatology.</rights><rights>2020, American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-89815b84effcbcf7ef1318c26c85f4c345553208a1ce571e4521ed168b0dd47a3</citedby><cites>FETCH-LOGICAL-c3889-89815b84effcbcf7ef1318c26c85f4c345553208a1ce571e4521ed168b0dd47a3</cites><orcidid>0000-0003-3448-5520 ; 0000-0003-1951-9411 ; 0000-0001-9547-218X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.41169$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.41169$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31729183$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Manasson, Julia</creatorcontrib><creatorcontrib>Wallach, David S.</creatorcontrib><creatorcontrib>Guggino, Giuliana</creatorcontrib><creatorcontrib>Stapylton, Matthew</creatorcontrib><creatorcontrib>Badri, Michelle H.</creatorcontrib><creatorcontrib>Solomon, Gary</creatorcontrib><creatorcontrib>Reddy, Soumya M.</creatorcontrib><creatorcontrib>Coras, Roxana</creatorcontrib><creatorcontrib>Aksenov, Alexander A.</creatorcontrib><creatorcontrib>Jones, Drew R.</creatorcontrib><creatorcontrib>Girija, Parvathy V.</creatorcontrib><creatorcontrib>Neimann, Andrea L.</creatorcontrib><creatorcontrib>Heguy, Adriana</creatorcontrib><creatorcontrib>Segal, Leopoldo N.</creatorcontrib><creatorcontrib>Dorrestein, Pieter C.</creatorcontrib><creatorcontrib>Bonneau, Richard</creatorcontrib><creatorcontrib>Guma, Monica</creatorcontrib><creatorcontrib>Ciccia, Francesco</creatorcontrib><creatorcontrib>Ubeda, Carles</creatorcontrib><creatorcontrib>Clemente, Jose C.</creatorcontrib><creatorcontrib>Scher, Jose U.</creatorcontrib><title>Interleukin‐17 Inhibition in Spondyloarthritis Is Associated With Subclinical Gut Microbiome Perturbations and a Distinctive Interleukin‐25–Driven Intestinal Inflammation</title><title>Arthritis &amp; rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>Objective To characterize the ecological effects of biologic therapies on the gut bacterial and fungal microbiome in psoriatic arthritis (PsA)/spondyloarthritis (SpA) patients. Methods Fecal samples from PsA/SpA patients pre‐ and posttreatment with tumor necrosis factor inhibitors (TNFi; n = 15) or an anti–interleukin‐17A monoclonal antibody inhibitor (IL‐17i; n = 14) underwent sequencing (16S ribosomal RNA, internal transcribed spacer and shotgun metagenomics) and computational microbiome analysis. Fecal levels of fatty acid metabolites and cytokines/proteins implicated in PsA/SpA pathogenesis or intestinal inflammation were correlated with sequence data. Additionally, ileal biopsies obtained from SpA patients who developed clinically overt Crohn's disease (CD) after treatment with IL‐17i (n = 5) were analyzed for expression of IL‐23/Th17–related cytokines, IL‐25/IL‐17E–producing cells, and type 2 innate lymphoid cells (ILC2s). Results There were significant shifts in abundance of specific taxa after treatment with IL‐17i compared to TNFi, particularly Clostridiales (P = 0.016) and Candida albicans (P = 0.041). These subclinical alterations correlated with changes in bacterial community co‐occurrence, metabolic pathways, IL‐23/Th17–related cytokines, and various fatty acids. Ileal biopsies showed that clinically overt CD was associated with expansion of IL‐25/IL‐17E–producing tuft cells and ILC2s (P &lt; 0.05), compared to pre–IL‐17i treatment levels. Conclusion In a subgroup of SpA patients, the initiation of IL‐17A blockade correlated with features of subclinical gut inflammation and intestinal dysbiosis of certain bacterial and fungal taxa, most notably C albicans. Further, IL‐17i–related CD was associated with overexpression of IL‐25/IL‐17E–producing tuft cells and ILC2s. These results may help to explain the potential link between inhibition of a specific IL‐17 pathway and the (sub)clinical gut inflammation observed in SpA.</description><subject>Antibodies, Monoclonal, Humanized - pharmacology</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Arthritis</subject><subject>Arthritis, Psoriatic - drug therapy</subject><subject>Arthritis, Psoriatic - metabolism</subject><subject>Arthritis, Psoriatic - microbiology</subject><subject>Bacteria</subject><subject>Biological effects</subject><subject>Biopsy</subject><subject>Computer applications</subject><subject>Correlation</subject><subject>Crohn's disease</subject><subject>Cytokines</subject><subject>Digestive system</subject><subject>Dysbacteriosis</subject><subject>Ecological effects</subject><subject>Fatty acids</subject><subject>Female</subject><subject>Fungi</subject><subject>Gastrointestinal Microbiome - drug effects</subject><subject>Gastrointestinal tract</subject><subject>Gene sequencing</subject><subject>Helper cells</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Inflammation - metabolism</subject><subject>Inflammatory diseases</subject><subject>Interleukin-17 - immunology</subject><subject>Interleukins</subject><subject>Intestinal microflora</subject><subject>Intestinal Mucosa - metabolism</subject><subject>Intestine</subject><subject>Intestines - drug effects</subject><subject>Intestines - microbiology</subject><subject>Lymphocytes T</subject><subject>Lymphoid cells</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Metabolic pathways</subject><subject>Metabolites</subject><subject>Metagenomics</subject><subject>Microbiomes</subject><subject>Microbiota</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Pathogenesis</subject><subject>Patients</subject><subject>Psoriatic arthritis</subject><subject>Rheumatic diseases</subject><subject>rRNA 16S</subject><subject>Spondylarthritis - drug therapy</subject><subject>Spondylarthritis - metabolism</subject><subject>Spondylarthritis - microbiology</subject><subject>Subgroups</subject><subject>Tumor Necrosis Factor Inhibitors - pharmacology</subject><subject>Tumor Necrosis Factor Inhibitors - therapeutic use</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdFKHDEUhkNpqWK96AuUQG_ai9WcZDKTuVzU2gHFUi29HDKZDBubSbZJpmXvfATBF-kz-SRmd1VooblJyPn4_sM5CL0FcgCE0EMZ0kEBUNYv0C5ltJxxSvjLpzfUsIP2Y7wm-dQVKQl_jXYYVLQGwXbRn8YlHayefhh3f3MLFW7cwnQmGe-wcfhy6V2_sj6nLEL-jbiJeB6jV0Ym3ePvJi3w5dQpa5xR0uLTKeFzo4LvjB81_qJDmkIn176IpeuxxMcmJuNUMr80_jue8vubu-OQC25TWXPZ2bjBynHcSN6gV4O0Ue8_3nvo26eTq6PPs7OL0-ZofjZTTIh6JmoBvBOFHgbVqaHSAzAQipZK8KFQrOCcM0qEBKV5BbrgFHQPpehI3xeVZHvow9a7DP7nlDtpRxOVtlY67afYUgac5BBaZ_T9P-i1n0JufE2JAgTlNcvUxy2VZxNj0EO7DGaUYdUCadebbPOM280mM_vu0Th1o-6fyae9ZeBwC_w2Vq_-b2rnX6-2ygdhaq13</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Manasson, Julia</creator><creator>Wallach, David S.</creator><creator>Guggino, Giuliana</creator><creator>Stapylton, Matthew</creator><creator>Badri, Michelle H.</creator><creator>Solomon, Gary</creator><creator>Reddy, Soumya M.</creator><creator>Coras, Roxana</creator><creator>Aksenov, Alexander A.</creator><creator>Jones, Drew R.</creator><creator>Girija, Parvathy V.</creator><creator>Neimann, Andrea L.</creator><creator>Heguy, Adriana</creator><creator>Segal, Leopoldo N.</creator><creator>Dorrestein, Pieter C.</creator><creator>Bonneau, Richard</creator><creator>Guma, Monica</creator><creator>Ciccia, Francesco</creator><creator>Ubeda, Carles</creator><creator>Clemente, Jose C.</creator><creator>Scher, Jose U.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3448-5520</orcidid><orcidid>https://orcid.org/0000-0003-1951-9411</orcidid><orcidid>https://orcid.org/0000-0001-9547-218X</orcidid></search><sort><creationdate>202004</creationdate><title>Interleukin‐17 Inhibition in Spondyloarthritis Is Associated With Subclinical Gut Microbiome Perturbations and a Distinctive Interleukin‐25–Driven Intestinal Inflammation</title><author>Manasson, Julia ; Wallach, David S. ; Guggino, Giuliana ; Stapylton, Matthew ; Badri, Michelle H. ; Solomon, Gary ; Reddy, Soumya M. ; Coras, Roxana ; Aksenov, Alexander A. ; Jones, Drew R. ; Girija, Parvathy V. ; Neimann, Andrea L. ; Heguy, Adriana ; Segal, Leopoldo N. ; Dorrestein, Pieter C. ; Bonneau, Richard ; Guma, Monica ; Ciccia, Francesco ; Ubeda, Carles ; Clemente, Jose C. ; Scher, Jose U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-89815b84effcbcf7ef1318c26c85f4c345553208a1ce571e4521ed168b0dd47a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antibodies, Monoclonal, Humanized - pharmacology</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Arthritis</topic><topic>Arthritis, Psoriatic - drug therapy</topic><topic>Arthritis, Psoriatic - metabolism</topic><topic>Arthritis, Psoriatic - microbiology</topic><topic>Bacteria</topic><topic>Biological effects</topic><topic>Biopsy</topic><topic>Computer applications</topic><topic>Correlation</topic><topic>Crohn's disease</topic><topic>Cytokines</topic><topic>Digestive system</topic><topic>Dysbacteriosis</topic><topic>Ecological effects</topic><topic>Fatty acids</topic><topic>Female</topic><topic>Fungi</topic><topic>Gastrointestinal Microbiome - drug effects</topic><topic>Gastrointestinal tract</topic><topic>Gene sequencing</topic><topic>Helper cells</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Inflammation - metabolism</topic><topic>Inflammatory diseases</topic><topic>Interleukin-17 - immunology</topic><topic>Interleukins</topic><topic>Intestinal microflora</topic><topic>Intestinal Mucosa - metabolism</topic><topic>Intestine</topic><topic>Intestines - drug effects</topic><topic>Intestines - microbiology</topic><topic>Lymphocytes T</topic><topic>Lymphoid cells</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Metabolic pathways</topic><topic>Metabolites</topic><topic>Metagenomics</topic><topic>Microbiomes</topic><topic>Microbiota</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Pathogenesis</topic><topic>Patients</topic><topic>Psoriatic arthritis</topic><topic>Rheumatic diseases</topic><topic>rRNA 16S</topic><topic>Spondylarthritis - drug therapy</topic><topic>Spondylarthritis - metabolism</topic><topic>Spondylarthritis - microbiology</topic><topic>Subgroups</topic><topic>Tumor Necrosis Factor Inhibitors - pharmacology</topic><topic>Tumor Necrosis Factor Inhibitors - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Manasson, Julia</creatorcontrib><creatorcontrib>Wallach, David S.</creatorcontrib><creatorcontrib>Guggino, Giuliana</creatorcontrib><creatorcontrib>Stapylton, Matthew</creatorcontrib><creatorcontrib>Badri, Michelle H.</creatorcontrib><creatorcontrib>Solomon, Gary</creatorcontrib><creatorcontrib>Reddy, Soumya M.</creatorcontrib><creatorcontrib>Coras, Roxana</creatorcontrib><creatorcontrib>Aksenov, Alexander A.</creatorcontrib><creatorcontrib>Jones, Drew R.</creatorcontrib><creatorcontrib>Girija, Parvathy V.</creatorcontrib><creatorcontrib>Neimann, Andrea L.</creatorcontrib><creatorcontrib>Heguy, Adriana</creatorcontrib><creatorcontrib>Segal, Leopoldo N.</creatorcontrib><creatorcontrib>Dorrestein, Pieter C.</creatorcontrib><creatorcontrib>Bonneau, Richard</creatorcontrib><creatorcontrib>Guma, Monica</creatorcontrib><creatorcontrib>Ciccia, Francesco</creatorcontrib><creatorcontrib>Ubeda, Carles</creatorcontrib><creatorcontrib>Clemente, Jose C.</creatorcontrib><creatorcontrib>Scher, Jose U.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis &amp; rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Manasson, Julia</au><au>Wallach, David S.</au><au>Guggino, Giuliana</au><au>Stapylton, Matthew</au><au>Badri, Michelle H.</au><au>Solomon, Gary</au><au>Reddy, Soumya M.</au><au>Coras, Roxana</au><au>Aksenov, Alexander A.</au><au>Jones, Drew R.</au><au>Girija, Parvathy V.</au><au>Neimann, Andrea L.</au><au>Heguy, Adriana</au><au>Segal, Leopoldo N.</au><au>Dorrestein, Pieter C.</au><au>Bonneau, Richard</au><au>Guma, Monica</au><au>Ciccia, Francesco</au><au>Ubeda, Carles</au><au>Clemente, Jose C.</au><au>Scher, Jose U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interleukin‐17 Inhibition in Spondyloarthritis Is Associated With Subclinical Gut Microbiome Perturbations and a Distinctive Interleukin‐25–Driven Intestinal Inflammation</atitle><jtitle>Arthritis &amp; rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>72</volume><issue>4</issue><spage>645</spage><epage>657</epage><pages>645-657</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>Objective To characterize the ecological effects of biologic therapies on the gut bacterial and fungal microbiome in psoriatic arthritis (PsA)/spondyloarthritis (SpA) patients. Methods Fecal samples from PsA/SpA patients pre‐ and posttreatment with tumor necrosis factor inhibitors (TNFi; n = 15) or an anti–interleukin‐17A monoclonal antibody inhibitor (IL‐17i; n = 14) underwent sequencing (16S ribosomal RNA, internal transcribed spacer and shotgun metagenomics) and computational microbiome analysis. Fecal levels of fatty acid metabolites and cytokines/proteins implicated in PsA/SpA pathogenesis or intestinal inflammation were correlated with sequence data. Additionally, ileal biopsies obtained from SpA patients who developed clinically overt Crohn's disease (CD) after treatment with IL‐17i (n = 5) were analyzed for expression of IL‐23/Th17–related cytokines, IL‐25/IL‐17E–producing cells, and type 2 innate lymphoid cells (ILC2s). Results There were significant shifts in abundance of specific taxa after treatment with IL‐17i compared to TNFi, particularly Clostridiales (P = 0.016) and Candida albicans (P = 0.041). These subclinical alterations correlated with changes in bacterial community co‐occurrence, metabolic pathways, IL‐23/Th17–related cytokines, and various fatty acids. Ileal biopsies showed that clinically overt CD was associated with expansion of IL‐25/IL‐17E–producing tuft cells and ILC2s (P &lt; 0.05), compared to pre–IL‐17i treatment levels. Conclusion In a subgroup of SpA patients, the initiation of IL‐17A blockade correlated with features of subclinical gut inflammation and intestinal dysbiosis of certain bacterial and fungal taxa, most notably C albicans. Further, IL‐17i–related CD was associated with overexpression of IL‐25/IL‐17E–producing tuft cells and ILC2s. These results may help to explain the potential link between inhibition of a specific IL‐17 pathway and the (sub)clinical gut inflammation observed in SpA.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31729183</pmid><doi>10.1002/art.41169</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-3448-5520</orcidid><orcidid>https://orcid.org/0000-0003-1951-9411</orcidid><orcidid>https://orcid.org/0000-0001-9547-218X</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 2326-5191
ispartof Arthritis & rheumatology (Hoboken, N.J.), 2020-04, Vol.72 (4), p.645-657
issn 2326-5191
2326-5205
language eng
recordid cdi_proquest_miscellaneous_2315098129
source MEDLINE; Wiley Online Library All Journals; Alma/SFX Local Collection
subjects Antibodies, Monoclonal, Humanized - pharmacology
Antibodies, Monoclonal, Humanized - therapeutic use
Arthritis
Arthritis, Psoriatic - drug therapy
Arthritis, Psoriatic - metabolism
Arthritis, Psoriatic - microbiology
Bacteria
Biological effects
Biopsy
Computer applications
Correlation
Crohn's disease
Cytokines
Digestive system
Dysbacteriosis
Ecological effects
Fatty acids
Female
Fungi
Gastrointestinal Microbiome - drug effects
Gastrointestinal tract
Gene sequencing
Helper cells
Humans
Inflammation
Inflammation - metabolism
Inflammatory diseases
Interleukin-17 - immunology
Interleukins
Intestinal microflora
Intestinal Mucosa - metabolism
Intestine
Intestines - drug effects
Intestines - microbiology
Lymphocytes T
Lymphoid cells
Male
Medical treatment
Metabolic pathways
Metabolites
Metagenomics
Microbiomes
Microbiota
Middle Aged
Monoclonal antibodies
Pathogenesis
Patients
Psoriatic arthritis
Rheumatic diseases
rRNA 16S
Spondylarthritis - drug therapy
Spondylarthritis - metabolism
Spondylarthritis - microbiology
Subgroups
Tumor Necrosis Factor Inhibitors - pharmacology
Tumor Necrosis Factor Inhibitors - therapeutic use
title Interleukin‐17 Inhibition in Spondyloarthritis Is Associated With Subclinical Gut Microbiome Perturbations and a Distinctive Interleukin‐25–Driven Intestinal Inflammation
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