A Tissue Atlas of Ulcerative Colitis to Guide TNF Inhibitor Therapy

Ulcerative colitis is a chronic-relapsing inflammatory disease of the large intestine with a complex, multifactorial pathogenesis. TNF inhibitors are widely used to suppress immune-mediated tissue damage in ulcerative colitis patients; however, therapy failures are common. Predicting TNF inhibitor response requires an understanding of the architectural features that underlie mucosal inflammation and those responsible for resistance. Here, we used highly multiplexed immunofluorescence to uncover the spatially resolved tissue architectures underlying disease progression and treatment response in 42 tissue regions from 34 individuals. We created a tissue atlas and performed spatial analysis to identify cell-cell contacts and cellular neighborhoods. We observed that cellular functional states depend on cellular neighborhood and that a subset of inflammatory cell types and cellular neighborhoods in ulcerative colitis patients persisted even during treatment with TNF inhibitor, indicating resistant niches. A computer vision model, with no a priori assumptions regarding cellular architectural features, was able to predict TNF inhibitor resistance. This spatial model significantly outperformed classification models based on single-cell data alone. Our results demonstrate the value of a spatial tissue atlas as a precision medicine tool to guide treatment of patients suffering from autoimmune diseases.