Overcoming challenges in IBD management: management of colonic dysplastic lesions

A Biomarker Panel to Detect Synchronous Neoplasm in Non-neoplastic Surveillance Biopsies from Patients with Ulcerative Colitis

BACKGROUND

Patients with ulcerative colitis (UC) are at risk for colorectal neoplasia. Challenges associated with surveillance colonoscopy with random biopsies for detection of dysplasia/cancer are well-documented. This study extended our findings in UC-associated colorectal cancer to include low-grade dysplasia (LGD) patients, testing whether our biomarker panel detects any UC-associated neoplasm.

METHODS

DNA from the LGD area and the corresponding nonadjacent, non-dysplastic section from 171 UC-LGD patients was extracted. TaqMan SNP Genotyping Assays for TNF-α, IL-1β, and IL23R were used to evaluate polymorphisms for each gene. Bisulfite-treated DNA was used for methylation testing of RUNX3, COX2, and MINT1. LGD data were combined with UC-cancer patient data for statistical testing. Logistic regression analyses determined associations between genetic/epigenetic/clinical variables and UC-associated neoplasia. Receiver operating characteristic analyses were performed to determine the final synchronous neoplasm detection panel.

RESULTS

Comparison of nonadjacent, non-dysplastic DNA from UC-neoplasm patients versus UC-controls indicated that TNF-α, IL-1β, and methylation of RUNX3, MINT1, and COX2 were significantly different (P < 0.0001). In multivariable analysis, all remained significant with an area under the curve of 0.85, exceeding the clinical variable panel area under the curve. Combining clinical and experimental variables yielded a neoplasm biomarker panel with an area under the curve of 0.95 (sensitivity and specificity of 82% and 91%, respectively). Analysis of DNA from LGD with known progression compared with LGD without progression indicated a significant difference in RUNX3 methylation.

CONCLUSIONS

A combined clinical, genetic, and epigenetic model for detecting synchronous neoplasm by testing of non-neoplastic colonic tissue had favorable operating characteristics and could complement current patient care.

Role of epithelial cells in the pathogenesis and treatment of inflammatory bowel disease

In the past decades, continuous effort has been paid to deeply understanding the pathophysiology of inflammatory bowel diseases (IBD), such as ulcerative colitis or Crohn's disease. As the disease typically arises as chronic inflammation of the gastrointestinal mucosa, research has been focused on how such an uncontrolled, deleterious immune response may arise and persist in a certain cohort of patients. Based on those immunologic analyses, the establishment of anti-TNF-α therapy, and the following series of biologic agents achieved great success and dramatically changed the therapeutic strategy of IBD patients. However, to guarantee long-term remission of the disease, the therapeutic standard has been raised to achieve "mucosal healing", which requires complete repair of the gastrointestinal mucosa. Recent studies have revealed the unexpected importance of epithelial cells in the pathophysiology of IBD. The general barrier function as well as the cell lineage-specific functions have been deeply attributed to the development of chronic intestinal inflammation. Also, the groundbreaking establishment of the in vitro intestinal stem cell culture system has opened up a way of developing stem cell transplantation therapy to treat otherwise refractory ulcers that may persist in IBD patients. In this review, we would like to focus on the role of epithelial cells in the pathophysiology of IBD, and also give a perspective to the upcoming development of regenerative therapies that may become one of the therapeutic choices to achieve mucosal healing in refractory patients of IBD.

Current scenario in inflammatory bowel disease: drug development prospects

BACKGROUND

Inflammatory bowel disease (IBD) pathophysiology have led to the development of various compounds that might ameliorate the disease process. Recently several failures in terms of developing disease-modifying therapies needs to be communicated effectively as per their process and cause which have led to a debate about the potential deficiencies in our understanding of the pathogenesis of IBD and choice of therapeutic targets. So that the thoroughly development of drug candidates and study design of clinical trials is done.

METHODS

Various online medical databases were searched for relevant study and publications. Different clinical trials were reviewed and the available data in clinical trials describing the effective drug development status of IBD medications.

RESULTS

The aminosalicylates, anti-inflammatory and biological molecules tested for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) but the risks of common and rare adverse events were found with treatment. Antibiotics and steroid help in reducing the immune response but further studies required on each molecule to substantiate treatment strategies. There has been significant research on different drug molecules as per the phase, which is summarized in this review.

CONCLUSIONS

Preclinical research on the complex IBD puzzle coupled with an active and vibrant research agenda in recent decades which might reveal patterns of pharmacological interactions instead of single potential drug targets. The increased collaboration between pharmaceutical companies, basic researchers and clinical researchers has the potential to bring us closer to developing an optimum pharmaceutical approach for the treatment of IBD.