Abstract Background CD4+ memory T cells (Tm) drive chronicity of inflammation in Crohn’s disease (CD). Variability in response to treatments specifically targeting Tmem hamper disease management. Recently, we have established that a subgroup of pediatric CD patients with high frequencies of circulating gut-homing IFN-g-secreting ex-Th17/Th1* TIGITneg Tmem at time of diagnosis develop a severe disease course. Specifically, they fail to reach remission within 6 months or lose remission within 1 year, despite anti-TNF treatment. As neutrophils are key targets of Tmem function, we hypothesized that pathogenic gut-homing IFN-g-secreting ex-Th17/Th1* TIGITneg Tmem alter intrinsic neutrophil transcriptional programming at an early stage, before the cells enter the tissue, associating with therapy resistant intestinal disease. Methods We analyzed clinically well-characterized therapy-naive pediatric CD patients (n=33) and IBD-negative controls (IBDneg;n=15) from the PIBD-SETQ cohort at time of diagnosis; performed bulk RNA-seq of purified circulating neutrophils, bulk RNAseq of intestinal biopsies, multiparameter flow cytometry of circulating immune cells and plasma proteomics using Proximity Extension Assay technology. Results At diagnosis, CD neutrophils differentially expressed 263 genes (DEGs) compared to IBDneg neutrophils. CD neutrophil transcriptomes were enriched for pathways related to neutrophil activation, granule biology, and IFN signaling. Hierarchical clustering of CD patients on the basis of the 263 DEGs identified two patient clusters: cluster_1 with a neutrophil transcriptional pattern similar to IBDneg, and cluster_2 with a pronounced enrichment in IFN and TNF signaling and complement genes. In line with our hypothesis, neutrophil cluster_2 patients had higher frequencies of circulating gut-homing IFN-g-secreting ex-Th17/Th1* TIGITneg Tm, reduced frequencies of inhibitory Tm and higher plasma concentrations IFN-g pathway-associated proteins including IFN-γ, CDCP1, and CXCL9 compared to cluster_1 patients. Crucially, lesional colonic biopsies of neutrophil cluster_2 patients were transcriptionally distinct from cluster_1 with a signature of increased IFN-g signaling, extracellular matrix re-organization and Fc-receptor expression but did not differ in the number of infiltrating neutrophils/mm2 or histological disease activity. In line with this distinctive immunotype, cluster_2 patients had higher clinical disease scores, higher endoscopic scores and lower rates of normal FCP remission at 1 year after diagnosis despite similar anti-TNF use compared to cluster_1 patients. Conclusion We define a subgroup of pediatric CD patients who have a distinctive pathogenic Tm-neutrophil immunotype at diagnosis and develop severe therapy resistant disease.
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