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Fiocchi C. Omics and Multi-Omics in IBD: No Integration, No Breakthroughs. Int J Mol Sci 2023; 24:14912. [PMID: 37834360 PMCID: PMC10573814 DOI: 10.3390/ijms241914912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
The recent advent of sophisticated technologies like sequencing and mass spectroscopy platforms combined with artificial intelligence-powered analytic tools has initiated a new era of "big data" research in various complex diseases of still-undetermined cause and mechanisms. The investigation of these diseases was, until recently, limited to traditional in vitro and in vivo biological experimentation, but a clear switch to in silico methodologies is now under way. This review tries to provide a comprehensive assessment of state-of-the-art knowledge on omes, omics and multi-omics in inflammatory bowel disease (IBD). The notion and importance of omes, omics and multi-omics in both health and complex diseases like IBD is introduced, followed by a discussion of the various omics believed to be relevant to IBD pathogenesis, and how multi-omics "big data" can generate new insights translatable into useful clinical tools in IBD such as biomarker identification, prediction of remission and relapse, response to therapy, and precision medicine. The pitfalls and limitations of current IBD multi-omics studies are critically analyzed, revealing that, regardless of the types of omes being analyzed, the majority of current reports are still based on simple associations of descriptive retrospective data from cross-sectional patient cohorts rather than more powerful longitudinally collected prospective datasets. Given this limitation, some suggestions are provided on how IBD multi-omics data may be optimized for greater clinical and therapeutic benefit. The review concludes by forecasting the upcoming incorporation of multi-omics analyses in the routine management of IBD.
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Affiliation(s)
- Claudio Fiocchi
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland, OH 44195, USA;
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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2
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Bastida Paz G, Merino Ochoa O, Aguas Peris M, Barreiro-de Acosta M, Zabana Y, Ginard Vicens D, Ceballos Santos D, Muñoz Núñez F, Monfort I Miquel D, Catalán-Serra I, García Sánchez V, Loras Alastruey C, Lucendo Villarín A, Huguet JM, de la Coba Ortiz C, Aldeguer Manté X, Palau Canós A, Domènech Morral E, Nos P. The Risk of Developing Disabling Crohn's Disease: Validation of a Clinical Prediction Rule to Improve Treatment Decision Making. Dig Dis 2023; 41:879-889. [PMID: 37611561 DOI: 10.1159/000531789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Crohn's disease (CD) is characterized by the development of complications over the course of the disease. It is crucial to identify predictive factors of disabling disease, in order to target patients for early intervention. We evaluated risk factors of disabling CD and developed a prognostic model. METHODS In total, 511 CD patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to identify demographic, clinical, and biological risk factors. A predictive nomogram model was developed in a subgroup of patients with noncomplicated CD (inflammatory pattern and no perianal disease). RESULTS The rate of disabling CD within 5 years after diagnosis was 74.6%. Disabling disease was associated with gender, location of disease, requirement of steroids for the first flare, and perianal lesions. In the subgroup of patients (310) with noncomplicated CD, the rate of disabling CD was 80%. In the multivariate analysis age at onset <40 years (OR = 3.46, 95% confidence interval [CI] = 1.52-7.90), extensive disease (L3/L4) (OR = 2.67, 95% CI = 1.18-6.06), smoking habit (OR = 2.09, 95% CI = 1.03-4.27), requirement of steroids at the first flare (OR = 2.20, 95% CI = 1.09-4.45), and albumin (OR = 0.59, 95% CI = 0.36-0.96) were associated with development of disabling disease. The developed predictive nomogram based on these factors presented good discrimination, with an area under the receiver operating characteristic curve of 0.723 (95% CI: 0.670-0.830). CONCLUSION We identified predictive factors of disabling CD and developed an easy-to-use prognostic model that may be used in clinical practice to help identify patients at high risk and address treatment effectively.
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Affiliation(s)
- Guillermo Bastida Paz
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Olga Merino Ochoa
- Gastroenterology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Mariam Aguas Peris
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Yamile Zabana
- Gastroenterology Department, Fundació per la Recerca Mútua Terrassa, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | - Fernando Muñoz Núñez
- University Hospital of Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | | | - Ignacio Catalán-Serra
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Centre of Molecular Inflammation Research (CEMIR) and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Carmen Loras Alastruey
- Gastroenterology Department, Fundació per la Recerca Mútua Terrassa, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | | | | | | | - Eugeni Domènech Morral
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Pilar Nos
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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3
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Lin V, Gögenur S, Pachler F, Fransgaard T, Gögenur I. Risk Prediction for Complications in Inflammatory Bowel Disease Surgery: External Validation of the American College of Surgeons' National Surgical Quality Improvement Program Surgical Risk Calculator. J Crohns Colitis 2023; 17:73-82. [PMID: 35973971 DOI: 10.1093/ecco-jcc/jjac114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Many patients with inflammatory bowel disease [IBD] require surgery during their disease course. Having individual risk predictions available prior to surgery could aid in better informed decision making for personalised treatment trajectories in IBD surgery. The American College of Surgeons National Surgical Quality Improvement Program [ACS NSQIP] has developed a surgical risk calculator that calculates risks for postoperative outcomes using 20 patient and surgical predictors. We aimed to validate the calculator for IBD surgery to determine its accuracy in this patient cohort. METHODS Predicted risks were calculated for patients operated for IBD between December 2017 and January 2022 at two tertiary centres and compared with actual outcomes within 30 postoperative days. Predictive performance was assessed for several postoperative complications, using metrics for discrimination and calibration. RESULTS Risks were calculated for 508 patient trajectories undergoing surgery for IBD. Incidence of any complication, serious complications, reoperation, and readmission were 32.1%, 21.1%, 15.2%, and 18.3%, respectively. Of 212 patients with an anastomosis, 19 experienced leakage [9.0%]. Discriminative performance and calibration were modest. Risk prediction for any complication, serious complication, reoperation, readmission, and anastomotic leakage had a c statistic of 0.605 (95% confidence interval [CI] 0.534-0.640), 0.623 [95% CI 0.558-0.688], 0.590 [95% CI 0.513-0.668], 0.621 [95% CI 0.557-0.685], and 0.574 [95% CI 0.396-0.751], respectively, and a Brier score of 0.240, 0.166, 0.138, 0.152, and 0.113, respectively. CONCLUSIONS The accuracy of risks calculated by the ACS NSQIP Surgical Risk Calculator was deemed insufficient for patients undergoing surgery for IBD, generally underestimating postoperative risks. Recalibration or additional variables could be necessary to predict risks in this cohort.
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Affiliation(s)
- Viviane Lin
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Denmark
| | - Seyma Gögenur
- Department of Surgery, Herlev Hospital, HerlevDenmark
| | | | - Tina Fransgaard
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Denmark.,Department of Surgery, Herlev Hospital, HerlevDenmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Denmark
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4
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Ellul P, Schembri J, Baldacchino VA, Molnar T, Resal T, Allocca MA, Furfaro F, Dal Buono, Theodoropoulou A, Fragaki M, Tsoukali E, Mantzaris GJ, Phillips F, Radford S, Moran G, Gonzalez HA, Sebastian S, Fousekis F, Christodoulou D, Snir Y, Lerner Z, Yanai H, Michalopoulos G, Tua J, Camilleri L, Papamichael K, Karmiris K, Katsanos K. Post-inflammatory polyps burden as a prognostic marker of disease-outcome in patients with inflammatory bowel disease. J Crohns Colitis 2022; 17:489-496. [PMID: 36322687 DOI: 10.1093/ecco-jcc/jjac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND AIM Post-inflammatory polyps (PIPs) are considered as indicators of previous episodes of severe inflammation and mucosal ulceration. Inflammatory bowel disease (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), exhibit a perpetuating, relapsing, and remitting pattern and PIPs is a frequent sequela of chronicity. The aim of this study was to determine whether a high PIPs burden is associated with a more severe disease course in patients with IBD. METHODS This was a multinational, multicentre, retrospective study. IBD patients previously diagnosed with PIPs were retrieved from the endoscopic database of each centre. PIPs burden was evaluated and associated with demographic and clinical data as well as factors indicating a more unfavorable disease course. RESULTS A total of 504 IBD patients with PIPs were recruited (male: 61.9%). The mean age at IBD diagnosis was 36.9 (±16.8) years. Most patients (74.8%) were diagnosed with UC. A high PIPs burden was present in 53.4% of patients. On multivariable Cox regression analysis, high PIPs burden was independently associated with treatment escalation (HR 1.35, 95% CI 1.04-1.75; P=0.024), hospitalization (HR 1.90; 95% CI 1.24 - 2.90; P=0.003), need for surgery (HR 2.28; 95% CI 1.17-4.44, P=0.02) and younger age at diagnosis (HR 0.99, 95% CI 0.98-0,99; p=0.003). CONCLUSION PIPs burden was associated with a more severe outcome. Future prospective studies should focus on the characterisation of PIPs burden as to further risk stratify this patient cohort.
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Affiliation(s)
- P Ellul
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - J Schembri
- Division of Gastroenterology, Mater Dei hospital, Malta
| | | | - T Molnar
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - T Resal
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - M A Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - F Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Dal Buono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Theodoropoulou
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - E Tsoukali
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - G J Mantzaris
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - F Phillips
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - S Radford
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - G Moran
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | | | - S Sebastian
- Hull University Teaching Hospitals, Hull, UK
| | - F Fousekis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Y Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Z Lerner
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - H Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - G Michalopoulos
- Gastroenterology department "Tzaneion" General Hospital of Piraeus, Greece
| | - J Tua
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - L Camilleri
- Faculty of Science, University of Malta, Malta
| | - K Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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5
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Lamb CA, Saifuddin A, Powell N, Rieder F. The Future of Precision Medicine to Predict Outcomes and Control Tissue Remodeling in Inflammatory Bowel Disease. Gastroenterology 2022; 162:1525-1542. [PMID: 34995532 PMCID: PMC8983496 DOI: 10.1053/j.gastro.2021.09.077] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease is characterized by significant interindividual heterogeneity. With a wider selection of pharmacologic and nonpharmacologic interventions available and in advanced developmental stages, a priority for the coming decade is to determine accurate methods of predicting treatment response and disease course. Precision medicine strategies will allow tailoring of preventative and therapeutic decisions to individual patient needs. In this review, we consider the future of precision medicine in inflammatory bowel disease. We discuss the critical need to extend from research focused on short-term symptomatic response to integrative multi-omic systems biology strategies to identify and validate biomarkers that underpin precision approaches. Crucially, the international community has collective responsibility to provide well-phenotyped and -curated longitudinal datasets for scientific discovery and validation. Research must also study broader aspects of the immune response, including components of the extracellular matrix, to better understand biological pathways initiating and perpetuating tissue fibrosis and longer-term disease complications.
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Affiliation(s)
- Christopher A Lamb
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Gastroenterology, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Aamir Saifuddin
- St Mark's Academic Institute, London North West University Hospitals National Health Service Trust, London, United Kingdom; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Nick Powell
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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6
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Wang S, Huang J, Liu F, Tan KS, Deng L, Lin Y, Tan W. Isosteviol Sodium Exerts Anti-Colitic Effects on BALB/c Mice with Dextran Sodium Sulfate-Induced Colitis Through Metabolic Reprogramming and Immune Response Modulation. J Inflamm Res 2021; 14:7107-7130. [PMID: 34992409 PMCID: PMC8709797 DOI: 10.2147/jir.s344990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Inflammatory bowel diseases (IBDs) are global health problems that are associated with immune regulation, but clinical IBDs treatment is currently inadequate. Effective preventive or therapeutic methods for immune disorders rely on controlling the function of immune cells. Isosteviol sodium (STV-Na) has antioxidant activity, but the therapeutic effect of STV-Na against IBD remain undocumented. Herein, we investigated the therapeutic effect of STV-Na in mice models with IBDs. METHODS Mice received 3.5% DSS for 7 days to establish IBD models. Intraperitoneal STV-Na was given 2 days before DSS and lasted for 9 days. Commercially available drugs used in treating IBDs (5-aminosalicylic acid, dexamethasone, and infliximab) were used as positive controls. Samples were collected 7 days after colitis induction. Histopathological score, biochemical parameters, molecular biology methods, and metabolomics were used for evaluating the therapeutic effect of STV-Na. RESULTS Our data revealed that STV-Na could significantly alleviate colon inflammation in mice with colitis. Specifically, STV-Na treatment improved body weight loss, increased colon length, decreased histology scores, and restored the hematological parameters of mice with colitis. The untargeted metabolomics analysis revealed that metabolic profiles were restored by STV-Na treatment. Furthermore, STV-Na therapy suppressed the number of CD68 macrophages and F4/80 cell infiltration. And STV-Na suppressed M1 and M2 macrophage numbers along with the mRNA expressions of proinflammatory cytokines. Moreover, STV-Na administration increased the number of regulatory T (Treg) cells while decreasing Th1/Th2/Th17 cell counts in the spleen. Additionally, STV-Na treatment restored intestinal barrier disruption in DSS-triggered colitis tissues by ameliorating the TJ proteins, increasing goblet cell proportions, and mucin protein production, and decreasing the permeability to FITC-dextran, which was accompanied by decreased plasma LPS and DAO contents. CONCLUSION These results indicate that STV-Na can ameliorate colitis by modulating immune responses along with metabolic reprogramming, and could therefore be a promising therapeutic strategy for IBDs.
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Affiliation(s)
- Shanping Wang
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People’s Republic of China
| | - Jiandong Huang
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People’s Republic of China
| | - Fei Liu
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People’s Republic of China
| | - Keai Sinn Tan
- College of Pharmacy, Jinan University, Guangzhou, People’s Republic of China
- Post-Doctoral Innovation Site, Jinan University, Yuanzhi Health Technology Co, Ltd, Zhuhai, People’s Republic of China
| | - Liangjun Deng
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People’s Republic of China
| | - Yue Lin
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People’s Republic of China
| | - Wen Tan
- Post-Doctoral Innovation Site, Jinan University, Yuanzhi Health Technology Co, Ltd, Zhuhai, People’s Republic of China
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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7
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Wyatt NJ, Speight RA, Stewart CJ, Kirby JA, Lamb CA. Targeting Leukocyte Trafficking in Inflammatory Bowel Disease. BioDrugs 2021; 35:473-503. [PMID: 34613592 DOI: 10.1007/s40259-021-00496-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 12/11/2022]
Abstract
In the last two decades, understanding of inflammatory bowel disease (IBD) immunopathogenesis has expanded considerably. Histopathological examination of the intestinal mucosa in IBD demonstrates the presence of a chronic inflammatory cell infiltrate. Research has focused on identifying mechanisms of immune cell trafficking to the gastrointestinal tract that may represent effective gut-selective targets for IBD therapy whilst avoiding systemic immunosuppression that may be associated with off-target adverse effects such as infection and malignancy. Integrins are cell surface receptors that can bind to cellular adhesion molecules to mediate both leukocyte homing and retention. In 2014, Vedolizumab (Entyvio®) was the first anti-integrin (anti-α4ß7 monoclonal antibody) treatment to be approved for use in IBD. Several other anti-integrin therapies are currently in advanced stages of development, including novel orally administered small-molecule drugs. Drugs targeting alternative trafficking mechanisms such as mucosal addressin cellular adhesion molecule-1 and sphingosine-1-phosphate receptors are also being evaluated. Here, we summarise key established and emerging therapies targeting leukocyte trafficking that may play an important role in realising the goal of stratified precision medicine in IBD care.
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Affiliation(s)
- Nicola J Wyatt
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - R Alexander Speight
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - Christopher J Stewart
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - John A Kirby
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Christopher A Lamb
- Faculty of Medical Sciences, Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
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