Nature. 2021 May;593(7858):275-281. doi: 10.1038/s41586-021-03484-5. | PubMed

Shikha Nayar^1,2, Joshua K Morrison³, Mamta Giri⁴, Kyle Gettler^1,4, Ling-Shiang Chuang¹, Laura A Walker⁵, Huaibin M Ko^6,7,8, Ephraim Kenigsberg¹, Subra Kugathasan⁹, Miriam Merad⁵, Jaime Chu³, Judy H Cho¹⁰

1. Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2. Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
3. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
4. The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
5. The Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
6. Department of Pathology, The Mount Sinai Hospital, New York, NY, USA.
7. Department of Medicine, The Mount Sinai Hospital, New York, NY, USA.
8. Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA.
9. Department of Pediatric Gastroenterology, Emory University, Atlanta, GA, USA.
10. The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. judy.cho@mssm.edu.

Abstract

Crohn's disease is a chronic inflammatory intestinal disease that is frequently accompanied by aberrant healing and stricturing complications. Crosstalk between activated myeloid and stromal cells is critical in the pathogenicity of Crohn's disease1,2, and increases in intravasating monocytes are correlated with a lack of response to anti-TNF treatment3. The risk alleles with the highest effect on Crohn's disease are loss-of-function mutations in NOD24,5, which increase the risk of stricturing6. However, the mechanisms that underlie pathogenicity driven by NOD2 mutations and the pathways that might rescue a lack of response to anti-TNF treatment remain largely uncharacterized. Here we use direct ex vivo analyses of patients who carry risk alleles of NOD2 to show that loss of NOD2 leads to dysregulated homeostasis of activated fibroblasts and macrophages. CD14+ peripheral blood mononuclear cells from carriers of NOD2 risk alleles produce cells that express high levels of collagen, and elevation of conserved signatures is observed in nod2-deficient zebrafish models of intestinal injury. The enrichment of STAT3 regulation and gp130 ligands in activated fibroblasts and macrophages suggested that gp130 blockade might rescue the activated program in NOD2-deficient cells. We show that post-treatment induction of the STAT3 pathway is correlated with a lack of response to anti-TNF treatment in patients, and demonstrate in vivo in zebrafish the amelioration of the activated myeloid-stromal niche using the specific gp130 inhibitor bazedoxifene. Our results provide insights into NOD2-driven fibrosis in Crohn's disease, and suggest that gp130 blockade may benefit some patients with Crohn's disease-potentially as a complement to anti-TNF therapy.

Presented By Shikha Nayar | ORCID iD