Inflammatory Bowel Diseases

IntroductionIntestinal barrier failure is a key characteristic of both kinds of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohns disease (CD). The intestinal barrier, or gut mucosal barrier, is composed of mucus and a tightly interconnected single layer of intestinal epithelial cells (IEC) that line the gut. Together, these components work to contain the gut microbiota within the gut lumen and when they fail, microbes, microbial products, or microbial components cause damage, inflammation, and immune activation in host tissue. We previously reported that High mobility group box 1 (HMGB1) in colonic mucus aggregates bacteria, limits bacterial invasion through mucus, and prevents bacteria from adhering to host tissue. Epithelial surface-associated HMGB1 is decreased in active UC lesions and low levels of HMGB1 are associated with high levels of tissue-adherent bacteria expressing adhesins carrying the molecular target of HMGB1 (ToH1). The study reported here was designed to determine whether HMGB1 defense is also compromised in active lesions from CD patients. MethodsImmunofluorescence microscopy was used to visualize mucus and HMGB1 in tissue from colonic resections performed in CD and non-IBD control patients. ResultsActive CD lesions had areas where the IEC were absent or pulling away from underlying tissue along with areas of increased mucus thickness and goblet cells full of mucus highly positive for alpha-linked-fucose residues. The surface associated HMGB1 was also decreased in active CD lesions. ConclusionTissue from CD patients exhibited cellular and acellular intestinal barrier defects in comparison to control patients. We observed the previously reported loss of IEC barrier integrity and abnormalities in the amount and distribution of mucus in CD lesions. We also report for the first time that CD is associated with decreased HMGB1 defense at the colon surface.

Cell division cycle 42 (Cdc42) is a member of the Rho family of small GTPases, which plays crucial roles in regulating cytoskeletal remodeling, and membrane trafficking. While previous studies implicated Cdc42 in controlling intestinal epithelial homeostasis, the involvement of this small GTPase in the process of intestinal fibrogenesis remains unexplored. Our study was designed to determine whether Cdc42 regulates the fibrogenic activation of intestinal myofibroblasts in vitro. The study was conducted using a CCD-18Co normal human colonic fibroblast cell line, and primary human intestinal myofibroblasts (HIMF) isolated from Crohns disease (CD) patients. CCD-18Co and HIMF cells were stimulated by transforming growth factor-{beta}1 (TGF-{beta}1). Cdc42 was inhibited either genetically, using siRNA-mediated knockdown, or pharmacologically using specific Cdc42 inhibitors, ML141 and CASIN. Genetic and pharmacologic inhibition of Cdc42 markedly reduced TGF-{beta}1 induced expression of the major contractile cytoskeletal proteins, -smooth muscle actin, calponin 1 and L-caldesmon. Furthermore, Cdc42 inhibition significantly attenuated expression of key extracellular matrix (ECM) proteins, fibronectin and collagen I, in activated CCD-18Co cells and HIMF. Interestingly, decreased expression of contractile and ECM proteins in Cdc42-depleted myofibroblasts was not due to downregulation of the TGF-{beta}1 signaling, decreased mRNA transcription or increased lysosomal or proteasomal degradation of these proteins. Such suppressed pro-fibrotic activation of Cdc42-deficient CCD-18Co cells and HIMF involved a selective inhibition of protein translation due to inactivation of the AKT-mammalian target of rapamycin (mTOR) signaling module. These findings highlight Cdc42 as a key regulator of intestinal fibrosis that controls mTOR activation to enhance ECM production and contractile actomyosin cytoskeleton in intestinal myofibroblasts.

Background and Aims: The molecular pathogenesis of Inflammatory Bowel Disease (IBD) remains unclear. We aimed to establish a high-resolution immune landscape of treatment-naive IBD to identify central drivers of disease onset and early pathogenic signalling. Methods: We generated a single-cell atlas using intestinal biopsies from a large adult inception cohort of 137 individuals, including treatment-naive Crohn's disease (CD), ulcerative colitis (UC), and symptomatic non-IBD controls. We integrated scRNA-seq (1 million cells) with co-varying neighbourhood analysis (CNA) and unbiased tensor decomposition of cell-cell communication (CCC) networks. Findings were validated in vitro macrophage stimulation model and using serum from patients. Results: The inception cohort exhibited significantly more homogenous compartmental diversity compared to benchmark reference studies (p < 0.001). Inflammation in both CD and UC was characterized by a marked expansion of inflammatory monocytes. Unbiased CCC analysis identified a dominant disease-specific signalling module centred on the Galectin family (LGALS1 and LGALS9). Galectin-9 expression was specifically enriched in inflammatory monocytes, which exhibited distinct. transcriptional programs linked to antigen presentation and microbial sensing. In vitro, Galectin-9 acted as a potent stimulus, driving macrophages toward a pro-inflammatory phenotype. Clinically, serum Galectin-9 levels were significantly elevated in IBD patients and correlated with systemic inflammatory markers and treatment response. Conclusions: Our data identify a galectin-monocyte signalling axis as a unifying inflammatory hallmark of early IBD. Galectin-9 serves as both a functional driver of mucosal inflammation and a dynamic biomarker, offering new opportunities for therapeutic targeting and disease monitoring from diagnosis. Keywords: Inflammatory Bowel Disease; Crohn's Disease; Ulcerative Colitis; Single-cell RNA sequencing; Galectin-9; Inflammatory monocytes.

Aims: Serrated lesions contribute substantially to colorectal cancer (CRC), while routine management of small distal hyperplastic polyps (HPs) assumes low risk. Surveillance guidelines nevertheless incorporate uncertainty at the HP/SSL interface and recommend shortened intervals for large serrated lesions. We tested whether fibroblast activation protein-alpha; (FAPalpha) expression by stromal fibroblasts within expert-reviewed HPs stratifies risk of subsequent neoplasia. Methods and results: In a single centre historical cohort, FAPalpha; immunohistochemistry (Abcam ab53066, 1:200) was performed on FFPE colon tissues from 64 patients (normal colon n=10; HP n=39; low grade TA n=6; high-grade TA n=4; adenocarcinoma n=5). FAPalpha positive stromal fibroblasts were quantified in 20 randomly selected fields at magnification 1000 by two blinded readers (ICC 0.93). Among 39 patients with expert reviewed index HPs and colonoscopic follow up, the endpoint was metachronous adenoma occurring in the same general colonic area as the index HP, with proximal defined as ascending colon and distal as descending colon. Follow-up colonoscopies were scheduled every 2 years for up to 10 years. ROC analysis identified an optimal threshold of [&ge;]9 FAPalpha positive fibroblasts (AUC 0.8658; sensitivity 81.25%, specificity 87.93%). FAPalpha high status (44% of HPs) was associated with shortened neoplasm free survival (log-rank p=0.0012): five-year neoplasm free survival 41% versus 91% for FAPalpha; no/low. In multivariable Cox modelling, FAPalpha high status remained independently associated with metachronous adenoma (HR 4.5, 95% CI 1.2-16.8, p=0.022). Conclusion: FAPalpha+ fibroblasts in expert-reviewed colorectal HPs identify a high-risk subgroup for metachronous adenoma, supporting stromal activation markers as a feasible pathology-anchored stratification tool.

Inflammatory bowel disease (IBD) arises from dysregulated crosstalk between innate immune, adaptive immune, and stromal compartments, yet the compartment-specific mechanisms driving tissue injury and tumorigenesis remain incompletely defined. To address this gap, we used conditional knockout and overexpression mouse models together with human IBD biopsy analysis to dissect the compartment-specific roles of lamin A/C in intestinal inflammation and colitis-associated tumorigenesis. Pan-hematopoietic lamin A/C deletion attenuated acute dextran sulfate sodium (DSS)-induced colitis. Myeloid-specific lamin A/C deletion ameliorated chronic colitis and was associated with altered dendritic cell (DC) programs, enhanced regulatory T cell (Treg) responses, and reduced effector T cell activation. Adoptive transfer of lamin A/C-deficient bone marrow-derived DCs recapitulated this reduced-damage phenotype in DSS colitis, while proteomic profiling revealed reduced antigen-processing and inflammatory programs together with enhanced metabolic and mucosal defense pathways. T cell-specific lamin A/C deletion reduced the Th1/Treg ratio and limited tumor development by suppressing chronic inflammation, whereas T cell-specific lamin A/C overexpression promoted severe Th1-skewed pathology, sustained intestinal inflammation, and increased colitis-associated tumor burden. Stromal fibroblast-specific lamin A/C deletion generated a tissue-protective niche characterized by enhanced epithelial barrier gene expression, regulatory cytokine production, and remodeling of the local immune milieu. Human IBD biopsies revealed compartment-specific lamin A/C alterations consistent with the murine findings. In lamina propria CD3+; T cells, lamin A/C levels were blunted in IBD and associated with local histological severity rather than IBD diagnosis, whereas epithelial lamin A/C showed a steeper crypt-axis spatial gradient in a Crohn's disease-specific pattern. Together, these findings identify lamin A/C as a cell-type- and context-dependent regulator of intestinal inflammation and tumorigenesis.

Inflammatory bowel disease (IBD) burden is rising globally, yet only subsets of patients benefit from available therapies, underscoring the need for more precise molecular and cellular stratification. In the PREDICT study, we enrolled treatment-naive pediatric patients with IBD, alongside disorders of gut-brain interaction (DGBI) controls and healthy donors, and profiled their intestinal and blood-derived T cells using single-cell RNA sequencing (scRNA-seq). Across 107 participants, we identify a unique population of cytotoxic CD4+ T cells (CD4 CTL) enriched in the inflamed gut of patients with Crohn's disease (CD) and ulcerative colitis. CD4 CTLs are clonally expanded and express cytotoxic effector molecules and IFNG, consistent with antigen-driven activation. Cell-cell interaction analyses implicate macrophage-derived IL-27 as the top candidate for CD4 CTL differentiation, and IL-27 blockade in a mouse model limits CD4 CTL formation. Notably, elevated CD4 CTL frequencies in gut and peripheral blood at diagnosis are associated with subsequent poor outcome of anti-TNF therapy in pediatric CD. Findings in our identification cohort are validated in an independent cohort and through reanalysis of published datasets. Importantly, we designed a simple flow cytometry panel to isolate blood CD4+ CXCR6+ CD27- T cells, which displayed a CD4 CTL transcriptional phenotype. Together, our results link CD4 CTLs to anti-TNF nonresponse and support their potential as an early, blood-accessible biomarker for treatment stratification in pediatric CD.

Stomach infection with the bacterium Helicobacter pylori (Hp) can cause chronic gastric inflammation, metaplasia (transdifferentiation of mature cell types), dysplasia (abnormal cells), and finally cancer. Obesity can also increase gastric cancer risk. However, host-Hp interactions during obesity are poorly understood. Here we investigated the impact of diet-induced obesity in two mouse models of Hp-associated disease. To model chronic gastric inflammation, we used C57BL/6 mice, and to model more severe disease, we used transgenic mice in which tamoxifen induces gastric expression of a constitutively active Kras allele, leading to metaplasia. We fed mice a high-fat diet (60% kilocalories from fat) to induce obesity, or a matched control diet (10% kilocalories from fat), then infected them with Hp or mock-infected them. In mock-infected C57BL/6 mice, high-fat diet had a minimal impact on gastric pathology and gene expression. In Hp-infected C57BL/6 mice, high-fat diet increased inflammation at the junction between the glandular stomach and non-glandular forestomach, a squamous epithelium similar to the human esophagus, and increased gastric expression of the cancer-associated genes Cldn7 and Reg3g. In KRAS+ mice with or without Hp infection, the impact of diet-induced obesity was more apparent, with increased metaplasia and dysplasia (abnormal cells). As well, high-fat diet caused an expansion of metaplastic pit cells, a lineage we previously found to be associated with Hp-driven inflammation. Thus, in these mouse models, diet-induced obesity does not directly drive gastric immunopathology, but enhances the development of pre-cancerous changes under susceptible conditions. IMPORTANCEMost gastric cancers are caused by stomach infection with the bacterium Helicobacter pylori. However, most infected individuals never develop cancer. Therefore, additional risk factors must tip the balance toward gastric cancer development. Obesity, or excessive body fat accumulation that poses a risk to health, is associated with gastric cancer development. However, specific mechanisms for obesity-driven gastric cancer risk are not well defined. Here we tested the hypothesis that obesity would exacerbate Helicobacter pylori-associated disease phenotypes using two clinically relevant mouse models. In wild-type mice, obesity induced by a very high-fat diet had a minimal impact on the stomach in the absence of infection, but increased the expression of some cancer-associated genes during infection. However, in mice with genetically driven pre-cancer, diet-induced obesity exacerbated the disease pathology, especially in infected mice. Therefore, obesitys impact on gastric cancer risk may be more evident in the later stages of the disease.

Antibiotics (ABXs) represent the current standard of care for treating Clostridioides difficile infection (CDI). Paradoxically, ABX-induced dysbiosis is the primary risk factor for CDI, as disruption of the colonic microbial ecosystem creates an opportunity for C. difficile colonization. Given that ABXs can also alter immune responses, we investigated whether ABXs prime the colonic immune milieu for CDI susceptibility. Here, we implicate ABXs in driving CDI severity through the emergence of pathogenic CCR5-reliant immune populations in the mouse colon. High-throughput immune cell profiling revealed that ABXs shift the colonic immune compartment toward a CCR5-associated type I immunity signature, marked by an expansion of CCR5+ ILC1s and CCR5+ Th1 cells. A partial genetic deletion of CCR5 reversed CDI severity, alleviating colonic inflammation and improving survival. Pharmacological inhibition of the CCL3/4/5-CCR5 circuit also recapitulated these favorable disease outcomes, which we attribute to reduced colonic CCR5+ ILC1, CCR5+ Th1, and CCR5+ CD8 T cell populations during CDI. Together, our findings extend beyond dysbiosis as the canonical CDI risk factor and establish ABX-induced immune imbalance as an underappreciated determinant of CDI susceptibility.

BackgroundBiliary atresia (BA) is a severe neonatal liver disease characterized by progressive fibrosis and bile duct obliteration. ObjectiveAlthough immune dysregulation is implicated in the pathogenesis of BA, the specific mechanisms driving bile duct injury remain incompletely understood. This study aimed to characterize tertiary lymphoid structures (TLSs) within extrahepatic biliary remnants (EBRs), identify their cellular mediators, and evaluate the therapeutic potential of targeting IL-21 receptor signaling. DesignWe performed integrated bulk RNA sequencing, single-cell RNA sequencing, spatial transcriptomics, multiplex immunohistochemistry, and flow cytometry on clinical samples from BA patients and non-BA cholestatic controls. TLS maturation was assessed by CD23 immunohistochemistry in EBRs from 148 BA patients and correlated with clinical parameters. Anti-IL-21R antibody treatment was evaluated in a rhesus rotavirus-induced BA mouse model, with treatment initiated on day 4 post-infection. ResultsTLSs were identified in BA EBRs with significantly higher prevalence than in matched liver tissues. Mature TLSs containing CD23 germinal centers were associated with elevated serum matrix metalloproteinase-7, more advanced hepatic fibrosis, and localized autoantibody deposition on injured bile ducts. Single-cell profiling revealed expanded CD4+ T peripheral helper (Tph) cells expressing IL-21 and CXCL13 within TLS-containing EBRs. Tph cells were enriched in peripheral blood of BA patients compared to non-BA cholestatic controls (P = 0.0025), and serum IL-21 was significantly elevated (P < 0.0001). Post-infection IL-21R blockade in the mouse model reduced jaundice incidence, improved weight gain, prevented extrahepatic biliary obstruction, and significantly improved long-term survival. ConclusionTLSs in BA extrahepatic biliary remnants harbor expanded Tph cells associated with IL-21-mediated B cell activation and bile duct injury. IL-21R blockade ameliorated disease in a murine BA model, identifying the IL-21/IL-21R axis as a potential therapeutic target warranting further investigation. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSImmune dysregulation contributes to biliary atresia (BA), with documented lymphocyte infiltration and defective B cell tolerance. However, the cellular mechanisms linking local immune activation to bile duct injury are unclear, and the roles of organized lymphoid structures and specific CD4 T cell subsets in orchestrating local humoral responses have not been characterized. What this study addsThis study demonstrates that mature tertiary lymphoid structures in extrahepatic biliary remnants are associated with disease severity markers and localized bile duct injury in BA. We identify T peripheral helper cells as an expanded IL-21-producing CD4 T cell population within these structures, and show that post-infection IL-21 receptor blockade prevents biliary obstruction and improves survival in a murine BA model. How this study might affect research, practice or policyThese findings identify the IL-21/IL-21R signaling axis as a candidate therapeutic target in BA warranting further preclinical and translational investigation. TLS maturation status in biliary remnants and serum autoantibody levels may serve as potential biomarkers of disease severity, meriting prospective evaluation in clinical cohorts.

Background Growing evidence suggests that the gut microbiome influences nasal and ocular allergic inflammation through gut-mucosal immune interactions. Yet, its association with Allergic rhinitis (AR) and allergic eye symptoms (AES) remains incompletely understood in large population-based cohorts. Objective To examine associations between the gut microbiome and self-reported AR and AES in Finnish adults. Methods Shallow metagenomic sequencing was performed on stool samples from a population-based cohort (FINRISK02; n = 7,231). Microbial taxonomic and functional profiles were compared between individuals with AR (n = 1,950), AES (n = 1,554), combined allergies (AR and/or AES; n = 2,305), and controls without reported symptoms (n = 3,175). Results Allergic groups exhibited lower microbial richness and phylogenetic diversity than controls. Shared microbial and functional signatures were observed across AR and AES, consistent with their high co-occurrence (N = 1,199). Compared with controls, allergic groups showed enrichment of 17 bacterial species, predominantly from the Clostridia class, including taxa previously associated with asthma, chronic obstructive pulmonary disease, and atopic dermatitis. Allergic individuals also exhibited enrichment of pathways related to mucosal carbohydrate processing, shikimate metabolism, histidine turnover, and broader amino acid metabolism. Concurrent enrichment of histidine biosynthesis and degradation suggested altered microbial histidine metabolism. Conclusions Adult allergic symptoms are associated with gut microbiome taxonomic and functional alterations linked to mucosal barrier function and immune-related metabolism, supporting a shared gut-mucosal immune axis across allergic phenotypes.

Cytotoxic chemotherapy remains a cornerstone of cancer treatment but is frequently limited by gastrointestinal toxicity associated with epithelial barrier disruption. Although chemotherapy profoundly perturbs the gut microbiota, it remains unclear whether these microbial alterations actively contribute to intestinal injury or merely reflect collateral tissue damage. Here, we dissect the respective contributions of direct drug toxicity and chemotherapy-induced dysbiosis to gut pathology using cytarabine (Ara-C), a chemotherapeutic agent associated with severe intestinal complications. We show that both Ara-C and post-Ara-C microbiota independently compromise intestinal barrier integrity. However, these effects arise through distinct host transcriptional programs: Whereas Ara-C directly induces interferon-associated inflammatory responses, post-Ara-C microbiota preferentially activate mucosal barrier defense pathways. Together, these findings identify chemotherapy-induced dysbiosis as an active driver of mucosal injury and provide a mechanistic rationale for microbiome-targeted strategies to mitigate treatment-associated toxicity.

Fibroproliferative diseases such as systemic sclerosis are complex conditions characterized by chronic skin inflammation and progressive fibrosis, with fibroblast activation as a central feature. While Transforming Growth Factor Beta (TGF-{beta}) signaling is a well-established driver of fibrosis in SSc, inflammatory pathways such as Nuclear Factor Kappa B (NF-{kappa}B) also contribute substantially to disease morbidity. We previously identified CD109 as a TGF-{beta} co-receptor and negative regulator of fibrotic signaling; however, its role in inflammatory signaling remains unknown. Here, we investigate the function of CD109 in regulating inflammatory signaling in skin fibroblasts. We show that, CD109 co-localizes and associates with Toll-like receptors (TLR2, TLR4) and tumor necrosis factor receptors (TNFRI, TNFRII), and that loss of CD109 enhances TNF--induced NF-{kappa}B activation and reprograms cytokine production in human dermal fibroblasts. Furthermore, both global and fibroblast-specific CD109 knockout mice exhibit increased immune cell infiltration and skin inflammation. In parallel, single-cell transcriptomic analyses across a pan-disease fibroblast atlas show that CD109 expression is preferentially maintained in structural and homeostatic fibroblast subtypes, whereas immune-interacting fibroblast subsets consistently display decreased CD109 levels. Pathway-level analyses of fibroblast pseudobulk samples reveal altered activity of canonical inflammatory pathways in SSc compared to healthy skin. Together, these findings identify CD109 as a fibroblast-intrinsic negative regulator of inflammatory signaling and suggest a broader role for CD109 in modulating inflammatory responses in systemic sclerosis. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=102 SRC="FIGDIR/small/736423v1_ufig1.gif" ALT="Figure 1"> View larger version (53K): org.highwire.dtl.DTLVardef@be9e08org.highwire.dtl.DTLVardef@794173org.highwire.dtl.DTLVardef@b81eb5org.highwire.dtl.DTLVardef@1e811f5_HPS_FORMAT_FIGEXP M_FIG Graphical Abstract: CD109 Restrains Fibroblast-Driven Inflammation by Modulating NF-{kappa}B Signaling. Generated using FigureLabs.ai and edited using Adobe Photoshop. C_FIG

Background & Aims: The association between upper gastrointestinal (GI) symptoms and delayed gastric emptying time (GET) is debated. This study utilized Body Surface Gastric Mapping (BSGM) and the 'Auckland Classification' BSGM phenotyping scheme to investigate whether symptom associations with GET vary across different mechanistic phenotypes. Methods: A pooled analysis was performed on two prospective datasets of 194 patients with chronic upper GI symptoms. Participants underwent simultaneous BSGM (Gastric Alimetry) and gastric emptying testing (breath test or scintigraphy). Validated time-of-test symptom profiling was recorded at 15-minute intervals using 0-10 Likert-type scales. Patients were classified: 'Spectral Abnormal' (abnormal electrophysiology), 'Sensorimotor' (symptoms correlate with gastric electrical amplitude), 'Continuous' (symptoms uncorrelated), and 'NA' (no phenotype). Results: In the analyzed cohort, 24% had delayed GET. Overall, delayed GET was associated with a higher total symptom burden (15.6 delayed vs. 8.8 normal, p=0.006; r=0.30, p<0.001), specifically postprandial fullness (p=0.004) and early satiation (p=0.015). However, associations varied significantly by phenotype. In the 'Sensorimotor' phenotype, nausea was associated with delayed GET (4.9 vs. 1.0, p=0.027; r=0.59, p=0.009), while total symptom burden was 23.3 vs. 8.4 (p=0.135). Conversely, patients with 'Continuous' or 'Spectral Abnormal' phenotypes, or who were unclassified, showed no symptom associations. Conclusions: Delayed GET is weakly associated with an increased burden of upper GI symptoms. However, gastroduodenal disorders are heterogeneous, such that phenotyping reveals this association to be exclusive to patients with a 'Sensorimotor' phenotype. These results could improve targeting of therapies that address gastric emptying.

Introduction: Acute pyelonephritis remains a major clinical problem. Relapses occur despite apparent-ly appropriate antibiotic therapy, suggesting that uropathogenic Escherichia coli (UPEC) persist in intrarenal niches. Intracellular bacterial reservoirs are a plausible explanation, but the relevant host cells, entry mechanisms and therapeutic implications in the kidney remain undefined. In principle, such reservoirs should favor choosing intracellularly active antibiotics, but increasing resistance to many of these agents leaves {beta}-lactams widely used in clinical practice, despite their predominantly extracellular activity. Methods: We analyzed murine pyelonephritis to identify the cellular reservoir of persistent UPEC. We generated mice genetically deficient for complement receptors CR3 and CR4 and tested their role in bacterial entry and persistence in vivo. Pharmacological complement receptor inhibition was applied to assess whether blocking bacterial re-entry into host cells improves antibiotic efficacy. Results: Renal MNP were identified as the major intracellular reservoir for UPEC in mice. Comple-ment opsonization enabled bacterial entry into these cells through CR3 and CR4, allowing UPEC to evade neutrophil-mediated killing and extracellularly active antibiotics. Genetic deletion of CR3 and CR4 abolished intracellular bacterial persistence and reduced renal bacterial burden. Because MNP undergo physiological turnover, intracellular UPEC must periodically exit host cells and infect new ones. Pharmacological inhibition of complement receptors prevented such bacterial re-entry and en-hanced the efficacy of {beta}-lactam antibiotics which cannot penetrate cell membranes. Conclusions: Complement receptor-mediated entry into renal MNP establishes an intracellular UPEC reservoir that promotes persistence during pyelonephritis. Blocking these receptors prevents renewal of the intracellular niche and improves {beta}-lactam efficacy in vivo.

Background: Pediatric chronic pancreatitis (CP) carries an elevated lifetime risk of pancreatic ductal adenocarcinoma (PDAC), yet the cellular and molecular mechanisms driving disease progression and early neoplastic transformation remain undefined. Methods: We performed single-nucleus RNA sequencing (snRNA-seq) on pancreatic tissue from 15 pediatric CP individuals and 6 healthy controls (HC). Findings were integrated with peripheral blood flow cytometry immunophenotyping of 8 CP and 7 HC individuals and validated by histopathological assessment. Findings: We identified 15 distinct cell populations and profound cellular remodeling in CP, including a 46% reduction in acinar cells and emergence of inflammatory fibroblasts as the dominant stromal population. Acinar-to-ductal metaplasia (ADM) and pancreatic intraepithelial neoplasia (PanIN) populations bearing early PDAC-associated transcriptional signatures were detected in most CP samples. Cell-cell interaction analysis revealed that 68% of CP-specific ligand-receptor interactions converged on ADM and PanIN populations via ECM-integrin and inflammatory pathways. Peripheral blood flow cytometry demonstrated concordant systemic immune activation, including elevated monocyte CCR2 and CD80, increased CD69 on T cells, and upregulated ROR{gamma}t in regulatory T cells. Interpretation: This atlas defines the cellular landscape and intercellular signaling networks underlying pediatric CP, identifying inflammatory fibroblasts and early neoplastic cell states as central features. These findings provide a molecular foundation for understanding cancer risk in pediatric CP and provide a resource to prioritize studies into potential therapeutic targets and biomarkers. Funding: This work was supported by the Network for Pancreatic Organ donors with Diabetes (nPOD) and The Leona M. & Harry B. Helmsley Charitable Trust.

The intestinal epithelium is continuously subjected to a variety of mechanical forces, including extrinsic peristaltic contractions and intrinsic tensile forces generated by epithelial cell migration. Yet, how these mechanical cues influence the cellular processes underlying intestinal homeostasis remains poorly understood. In this study, we examine the impact of mechanical forces on intestinal cell dynamics by applying controlled external stretch to intestinal organoids, combined with high-throughput single-cell transcriptomic profiling. Our analyses reveal that prolonged cyclic mechanical strain alters the composition of differentiated intestinal cell populations. Specifically, we identify a strain-induced shift in the absorptive lineage towards a less mature state, with expansion of the population of early-stage enterocytes at the crypt-villus interface. This shift is associated with downregulation of transcriptional programs controlling enterocyte maturation within absorptive precursor populations. Our findings indicate that mechanical strain directs the maturation of the intestinal absorptive lineage, and highlight a role for mechanical forces in shaping intestinal epithelial composition and function.

Women are predisposed to systemic lupus erythematosus (SLE) with a prevalence ratio of up to 9:1 over men. Multiple mouse strains including NZM2328 exhibit strong female dominance in developing spontaneous lupus as in humans with SLE. While lupus-prone mice can develop disease under germ free (GF) condition, the role of gut microbiota in female bias for lupus nephritis is not investigated systematically. Here, using specific pathogen free (SPF) and GF NZM2328 mice, and employing microbiota-depletion and microbial-association strategies, we show that microbiota influences lupus-like disease outcomes differently in males and females. Female NZM2328 mice with intact microbiota presents higher inflammation factor expression, including X-chromosome linked TLRs, in the distal gut and systemic compartments, and higher activation of genes and biological pathways such as neutrophil extracellular trap (NET) formation and complement and coagulation cascade (CCC) pathways, associating with their higher disease susceptibility. Gut microbiota-depletion as well as GF derivation eliminated not only the modest differences in the serum and fecal antibody levels and nAg reactivity, but also the gender bias in the timing of clinical stage disease onset as well as systemic NET and CCC pathway activation. Reciprocally, conventionalization of GF NZM2328 mice at juvenile age restored the female bias in intestinal and systemic autoantibody levels, pro-inflammatory immune pathway activation, and the timing of clinical stage disease onset. Overall, our observations show that, while genetic susceptibility appears to be the cause of lupus-like disease in NZM2328 mice, differential activation of NET and CCC pathways in males and females upon exposure to gut microbes, in combination with host-factors, causes gender bias in disease outcomes. We conclude that microbiota exposure-dependent protection of males and overactivation of NET and CCC pathways in females could be contributing to the female bias in lupus-like disease in NZM2328 mice.

Hirschsprung disease (HSCR) is a rare congenital disorder of the enteric nervous system (ENS), marked by the absence of enteric ganglia along variable lengths of the distal gastrointestinal tract, resulting in functional intestinal obstruction. Individuals with Trisomy 21 (Down syndrome) face a 50- to 100-fold increased risk of HSCR relative to the general population, yet the molecular basis of this susceptibility remains poorly understood. Here, we investigated this association using isogenic induced pluripotent stem cells (iPSCs) derived from a mosaic individual with Down syndrome, enabling direct comparison of Trisomy 21 and Disomy 21 cells within an identical genetic background following differentiation into enteric neural crest-derived cells (ENCDCs). Trisomy 21 ENCDCs exhibited reduced proliferative and migratory capacity and an impaired ability to differentiate into enteric neurons relative to Disomy 21 controls. These phenotypes were accompanied by decreased RET expression at both the transcript and protein levels, together with broad downregulation of the RET gene regulatory network, including GDNF, GFRA1, EDNRB, SEMA3C, and NRG1, and of cell cycle and DNA replication pathways. Strikingly, we identified SOD1, a chromosome 21-encoded antioxidant enzyme not previously linked to RET regulation, as a dosage-sensitive driver of this effect: SOD1 overexpression in disomic ENCDCs was sufficient to suppress RET, whereas shRNA-mediated knockdown in Trisomy 21 ENCDCs restored RET expression. Mechanistically, Trisomy 21 ENCDCs displayed markedly elevated catalase and a redox imbalance, and exogenous hydrogen peroxide recapitulated RET suppression in disomic cells, implicating oxidative stress as a mediator of RET downregulation. Collectively, these findings establish Trisomy 21 dosage effects as disruptors of RET-dependent enteric neural crest development and implicate SOD1-driven oxidative stress as a candidate mechanism, providing a framework for understanding the elevated risk of HSCR in Down syndrome.

Corneal epithelial integrity depends on continuous epithelial renewal by limbal epithelial stem cells (LESCs), a process tightly linked to sensory innervation. Loss or impairment of innervation causes neurotrophic keratopathy (NK), a sight-threatening degenerative disease for which rhNGF, the only FDA-approved pharmacologic therapy, often has limited efficacy in advanced or refractory disease. The mechanistic basis for this limited response remains unclear. Using surgical, genetic, and pharmacologic approaches in a rodent model of NK with corneal Schwann cell ablation or structural and functional denervation, together with primary human LESCs, we examined how denervation alters NGF receptor signaling during epithelial repair. In innervated corneas, NGF promoted epithelial regeneration through TrkA. Denervation, however, increased expression of a second NGF receptor, anti-regenerative p75NTR, and activation of its effector JNK, and reduced the activity of the TrkA effector AKT in LESCs. In this altered receptor context, denervation-induced elevation of endogenous NGF amplified p75NTR signaling, thereby explaining the failure of topical rhNGF to rescue severely denervated NK phenotype corneas. Conversely, selective TrkA activation, either with the clinical-stage agonist tavilermide, or pharmacologic or genetic inhibition/ablation of p75NTR, restored AKT signaling and rescued epithelial healing in denervated corneas independent of reinnervation. These findings identify a nerve-dependent NGF receptor switch as a key regulator of corneal epithelial renewal and establish receptor-selective modulation as a mechanistically rational therapeutic strategy for treating NK. One Sentence SummaryCorneal denervation shifts limbal epithelial stem cell signaling from pro-regenerative TrkA-AKT toward anti-regenerative p75NTR-JNK, explaining the limited efficacy of recombinant human nerve growth factor (rhNGF; cenegermin), the only approved pharmacologic therapy for neurotrophic keratopathy, in severely denervated corneas and identifying receptor-selective modulation as a mechanistically distinct therapeutic strategy.

The IgG Fc chain carries a single N-linked glycan which may undergo changes. Increased agalactosylated N-glycans are associated with rheumatoid arthritis (RA) and regarded as pro-inflammatory. Dysregulated neutrophils can make important contributions to host tissue damage. In RA, immune complexes (ICs) that have precipitated onto synovial joint surfaces activate neutrophils via Fc receptors, promoting localised inflammation. We engineered recombinant human monoclonal IgG with agalactosylated or galactosylated N-glycans, generated immobilised ICs and stimulated healthy donor and RA patient blood-derived neutrophils, comparing reactive oxygen species (ROS) production as read-out of neutrophilic inflammation. Both healthy donor and RA patient neutrophils generated less ROS when stimulated with ICs made from agalactosylated IgG. Mechanistically this was due to poorer binding of agalactosylated ICs to neutrophil FcgammaRs, causing lower activation of Akt and p38 MAPK. Both are required for immobilised IC-mediated stimulation of the neutrophil NADPH oxidase. Taken together, this suggests that disease-associated, agalactosylated IgG does not in fact promote inflammation and host tissue injury, at least not by acting on neutrophils. We propose that rather than promoting inflammation, agalactosylated IgG N-glycans that accompany inflammatory disease may arise as part of a compensatory mechanism that is aimed at reducing excessive inflammation and host tissue injury.