Invariant natural killer T-cell and CD4+ T-cell derived IL22 is a regulator of epithelial-to-mesenchymal transition and extracellular matrix remodelling in perianal fistulas

Background and aimsPerianal fistulization is a challenging phenotype of Crohns disease (CD). Unravelling the cytokine networks and cellular mediators driving tissue injury in perianal CD (pCD) will help inform much needed novel treatment strategies. MethodsThe phenotype of different T-cell subsets, including unconventional lineages, such as {gamma}{delta} T-cells, MAIT and iNKT-cells in fistula tract tissue and blood samples of patients with pCD or cryptoglandular perianal fistulas was determined using multiparameter flow cytometry. Transcriptomic profiling of fistula tract tissue was performed by RNA-sequencing. ResultsCD161+ CD4+ T-cells and CD161+ CD4- CD8- iNKT-cells significantly accumulated in fistula tissue and produced interleukin-(IL)22 and IL13. Transcripts associated with epithelial-to-mesenchymal transition (EMT), extracellular matrix (ECM) remodelling, interferon-gamma, JAK-STAT and lymphocyte signalling were enriched in pCD, as well as inhibition of pathways associated with wound closure. IL22-responsive transcripts were significantly enriched in fistulas and network analysis identified IL22-mediated regulation of EMT, ECM and other inflammatory pathways. ConclusionThis study provides novel molecular and cellular insights into fistula pathogenesis, identifying IL22 producing lymphocytes as novel immune regulators of EMT and ECM dysregulation in perianal fistulas. Targeting the regulatory networks controlling IL22 producing lymphocytes may offer novel therapeutic strategies in pCD.