An intestinal organoid-based platform that recreates susceptibility to T-cell-mediated tissue injury

A goal in precision medicine is to use patient -derived material to predict disease course and intervention outcomes. Here, we use mechanistic observations in a preclinical animal model to design an ex vivo platform that recreates genetic susceptibility to T-cell-mediated damage. Intestinal graft -versus -host disease (GVHD) is a life -threatening complication of allogeneic hematopoietic cell transplantation. We found that intestinal GVHD in mice deficient in Atg16L1, an autophagy gene that is polymorphic in humans, is reversed by inhibiting necroptosis. We further show that cocultured allogeneic T cells kill Atg16L1- mutant intestinal organoids from mice, which was associated with an aberrant epithelial interferon signature. Using this information, we demonstrate that pharmacologically inhibiting necroptosis or interferon signaling protects human organoids derived from in- dividuals harboring a common ATG16L1 variant from allogeneic T -cell attack. Our study provides a roadmap for applying findings in animal models to individualized therapy that targets affected tissues. (Blood. 2020;135(26):2388-2401)