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Review
. 2022 May 11;16(Supplement_2):ii3-ii19.
doi: 10.1093/ecco-jcc/jjac034.

Interleukin-23 in the Pathogenesis of Inflammatory Bowel Disease and Implications for Therapeutic Intervention

Gavin W Sewell  1   2 , Arthur Kaser  1   2
Affiliations
Review

Interleukin-23 in the Pathogenesis of Inflammatory Bowel Disease and Implications for Therapeutic Intervention

Gavin W Sewell et al. J Crohns Colitis. .

Abstract

The interleukin-23 [IL-23] cytokine, derived predominantly from macrophages and dendritic cells in response to microbial stimulation, has emerged as a critical promoter of chronic intestinal inflammation. Genome-wide association studies linking variants in IL23R to disease protection, bolstered by experimental evidence from colitis models, and the successful application of therapies against the IL-12/IL-23 shared p40 subunit in the treatment of inflammatory bowel disease [IBD] all provide compelling evidence of a crucial role for IL-23 in disease pathogenesis. Moreover, targeting the p19 subunit specific for IL-23 has shown considerable promise in recent phase 2 studies in IBD. The relative importance of the diverse immunological pathways downstream of IL-23 in propagating mucosal inflammation in the gut, however, remains contentious. Here we review current understanding of IL-23 biology and explore its pleiotropic effects on T cells, and innate lymphoid, myeloid and intestinal epithelial cells in the context of the pathogenesis of IBD. We furthermore discuss these pathways in the light of recent evidence from clinical trials and indicate emerging targets amenable to therapeutic intervention and translation into clinical practice.

Keywords: Crohn’s disease; Interleukin-23; ulcerative colitis.

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Figures

Figure 1.
Figure 1.
Generation of the pro-inflammatory cytokine IL-23 and its downstream signalling via the IL-23 receptor.
Figure 2.
Figure 2.
The IL-23/Th17 axis.
Figure 3.
Figure 3.
IL-23 promotes intestinal inflammation through pleiotropic effects on innate and adaptive immune cells.
See this image and copyright information in PMC

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