1. Tofacitinib-Induced Modulation of Intestinal Adaptive and Innate Immunity and Factors Driving Cellular and Systemic PharmacokineticsSummary
- Author
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Andreas Zollner, Nicole Przysiecki, Sophie Macheiner, Vera Reinstadler, Barbara Jelusic, Simon J. Reider, Herbert Tilg, Christina Watschinger, Alexandra Pfister, Herbert Oberacher, Alexander R. Moschen, and Bernhard Texler
- Subjects
JAKi, Janus kinase inhibitor ,medicine.medical_treatment ,PHA, phytohemagglutinin ,Cell Communication ,RC799-869 ,Pharmacology ,CD8-Positive T-Lymphocytes ,M-CSF, macrophage colony-stimulating factor ,IEC, intestinal epithelial cell ,Mice ,DI, division index ,Piperidines ,TNF-α, tumor necrosis factor α ,Original Research ,tofacitinib ,IBD, inflammatory bowel disease ,Chemistry ,LC-MS/MS, liquid chromatography–tandem mass spectrometry ,Gastroenterology ,PI, proliferation index ,CFSE, carboxyfluorescein succinimidyl ester ,ELISA, enzyme-linked immunosorbent assay ,Diseases of the digestive system. Gastroenterology ,Acquired immune system ,mRNA, messenger RNA ,Cytokine ,medicine.anatomical_structure ,Editorial ,JAK inhibitor ,LPS, lipopolysaccharide ,medicine.symptom ,JAK, Janus kinase ,pharmacokinetics ,IHC, immunohistochemistry ,PBMC, peripheral blood mononuclear cell ,ATP, adenosine triphosphate ,FSC, forward scatter ,Regulatory T cell ,PBS, phosphate-buffered saline ,IFNγ, interferon γ ,Inflammation ,STAT, signal transducers and activator of transcription ,Immune system ,inflammatory bowel disease ,DSS, dextran sulfate sodium ,3D, 3-dimensional ,medicine ,CD, Crohn’s disease ,Animals ,Humans ,Th, T helper ,Innate immune system ,Tofacitinib ,Hepatology ,mucosal inflammation ,Immunity, Innate ,IL, interleukin ,UC, ulcerative colitis ,Pyrimidines ,Janus kinase ,ENT, equilibrative nucleoside transporter ,ASV, amplicon sequence variant - Abstract
Objective By interfering with multiple cytokines, human Janus kinase inhibitors (JAKis) are of growing importance in the treatment of malignant and inflammatory conditions. Although tofacitinib has demonstrated efficacy as the first-in-class JAKi in ulcerative colitis many aspects concerning its mode of action and pharmacokinetics remain unresolved. Design We studied tofacitinib’s impact on various primary human innate and adaptive immune cells. In-depth in vivo studies were performed in dextran sodium sulfate–induced colitis in mice. Immune populations were characterized by flow cytometry and critical transcription factors and effector cytokines were analyzed. Pharmacokinetics of tofacitinib was studied by liquid chromatography–tandem mass spectrometry. Results Tofacitinib inhibited proliferation in CD4+ and CD8+ T cells along with Th1 and Th17 differentiation, while Th2 and regulatory T cell lineages were largely unaffected. Monocytes and macrophages were directed toward an anti-inflammatory phenotype and cytokine production was suppressed in intestinal epithelial cells. These findings were largely reproducible in murine cells of the inflamed mucosa in dextran sulfate sodium colitis. Short-term treatment with tofacitinib had little impact on the mouse microbiota. Strikingly, the degree of inflammation and circulating tofacitinib levels showed a strong positive correlation. Finally, we identified inflammation-induced equilibrative nucleoside transporters as regulators of tofacitinib uptake into leukocytes. Conclusions We provide a detailed analysis of the cell-specific immune-suppressive effects of the JAKis tofacitinib on innate and adaptive immunity and reveal that intestinal inflammation critically impacts tofacitinib’s pharmacokinetics in mice. Furthermore, we describe an unappreciated mechanism—namely induction of equilibrative nucleoside transporters—enhancing baseline cellular uptake that can be inhibited pharmaceutically., Graphical abstract
- Published
- 2022