Abstract Background Failure to respond to the anti-α4β7 integrin therapy, vedolizumab, is observed in a subset of inflammatory bowel disease (IBD) patients, potentially linked to distinct T cell activation profiles. This study aims to characterize the transcriptional and phenotypic features of circulating memory CD4⁺ T cells in vedolizumab non-responders and their association with treatment resistance. Methods We performed multidimensional flow cytometry and single-cell RNA sequencing to analyze IBD patients' circulating memory CD4⁺ T cell compartment, comparing pre- and post-treatment peripheral blood samples from vedolizumab responders and non-responders. Proteogenomic analysis and TCR repertoire profiling of CD4⁺ T cells were conducted using matched peripheral blood samples. Flow cytometry characterized T cell subsets based on surface markers, migration receptors, transcription factors, and cytokine expression, focusing on differences in activation and migration profiles. Results Ki67⁺ cells were enriched in the memory CD4⁺ T cell population of vedolizumab non-responders in both UC and CD, confirmed by two independent cohorts. TCR repertoire analysis showed increased diversity in memory CD4⁺ T cells post-treatment. Single-cell sequencing and proteomics revealed these Ki67⁺ cells had a high activation and proliferation profile (HLA-DR, CD40LG, MKI67) with reduced IL7R and SELL expression. They displayed elevated integrins (α4, β1, β7) and gut-homing receptors (CXCR3, CCR6). Upregulated T-bet, EOMES, and RORγt and increased IL-17A, indicated a pro-inflammatory Th1/Th17 phenotype in non-responders. Conclusion Ki67⁺ memory CD4⁺ T cells are significantly enriched in the peripheral blood of vedolizumab non-responders, displaying a distinct transcriptional and phenotypic profile characterized by Th1/Th17 polarization, high integrin α4β1 expression, and enhanced gut-homing capacity. These findings indicate that proliferating effector memory CD4⁺ T cells could contribute to therapy resistance in IBD, emphasizing the need for alternative therapeutic strategies targeting these cells in anti-α4β7 integrin therapy non-responders.
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