Cytokine interaction networks, not individual cytokines, drive anti-TNF response in Crohn's disease

Crohns disease (CD) is a chronic inflammatory condition of the gastrointestinal tract for which anti-tumour necrosis factor (anti-TNF) agents remain a first-line biologic therapy. However, remission rates are modest, and the mechanistic basis of non-response is poorly characterised. A common resistance mechanism is thought to emerge when alternative inflammatory cascades compensate for TNF inhibition, but the interactions underlying this rewiring have not been systematically characterised. We applied CytokineLink, our previously developed systems immunology framework, to single-cell RNA sequencing data from CD patients sampled before and after anti-TNF therapy. We reconstructed networks of interacting cytokines across samples stratified by treatment phase, response, and inflammation status, and identified condition-specific cytokine interactions and feedback loops, statistically validated against degree-matched random networks. We clustered the generated networks based on their inflammation, response, and treatment status. The pre-treatment inflamed non-responder network contained the largest set of unique interactions, organised around a connected module driven by IL17C targeting downstream TNF, IL6, IL1B, CXCL1/2/3/8, and CCL20. IL17C was produced by a population of non-ileal enteroendocrine cells, differentially abundant at baseline in non-responders. Gene set variation analysis in an independent cohort confirmed elevated non-responder module activity in colonic tissues of non-responders. Feedback loop analysis revealed that responder networks were characterised by persistent IL10 circuits sustained by macrophage populations and acquired tissue-remodelling interactions after therapy, whereas non-responders lost IL10 feedback loops post-treatment and gained TNF-containing motifs, including circuits signalling through the upstream activator TL1A. Our findings characterise the mechanism of anti-TNF non-response as a cytokine network, in which pre-existing epithelial-driven inflammatory modules and the failure to preserve regulatory feedback sustain TNF-independent inflammation in CD. By characterising cytokine interactions at the systems level, our approach moves beyond single-cytokine models of anti-TNF resistance to provide a mechanistic framework for understanding the biological basis of treatment failure in immune mediated diseases.