Dr Cecilia Ansalone in a white lab coat and blue gloves examines a tissue sample on a microscope in a laboratory. A monitor displays a magnified image of the biopsy sample, and lab equipment and notes are visible on the bench.

A collaborative study led by the School of Infection & Immunity, in partnership with Eli Lilly and Company and NHS Greater Glasgow and Clyde, has uncovered how immune features in artery tissue at diagnosis can help predict whether patients with giant cell arteritis (GCA) will respond to standard steroid treatment.

Published in Annals of the Rheumatic Diseases in October, this study, titled Spatial profiling of giant cell arteritis tissues reveals immune heterogeneity and potential predictors of glucocorticoid response, is the first to combine spatial transcriptomics and advanced imaging with clinical outcome data in GCA.

GCA is a serious inflammatory disease that affects large arteries in people aged 50 and over and can lead to complications such as vision loss, aneurysms, and stroke. 

Steroids (glucocorticoids) are the main treatment, but up to half of patients do not achieve lasting remission and may require long-term, high-dose therapy, putting them at risk of side effects like osteoporosis, diabetes, and infections.

The researchers analysed artery biopsies taken at diagnosis and tracked how patients responded to treatment over time and discovered that patients who went into sustained remission had a high number of plasma cells in the outer layer of the artery wall. 

In contrast, patients who did not respond well to steroids showed signs of active tissue remodelling and T cell activation.

By combining markers for plasma cells and macrophages, the team was able to predict treatment response with over 85 per cent accuracy. This opens the door to a more personalised approach to GCA treatment, where decisions could be guided by a patient’s unique immune profile from the outset.

Dr Cecilia Ansalone, first author and Sii Research Fellow, said: “By mapping the immune environment of inflamed arteries in unprecedented detail, we have identified molecular patterns that can predict how patients respond to treatment. 

"This means that a routine biopsy, already part of standard diagnosis, could also guide treatment decisions. 

"It has the potential to revolutionise how we care for people with giant cell arteritis by enabling more personalised and effective therapies from the very beginning.”

First published: 12 December 2025

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