Precision medicine in inflammatory bowel disease: concept, progress and challenges

Abstract

Crohn’s disease and ulcerative colitis are increasingly prevalent, relapsing and remitting inflammatory bowel diseases (IBDs) with variable disease courses and complications. Their aetiology remains unclear but current evidence shows an increasingly complex pathophysiology broadly centring on the genome, exposome, microbiome and immunome. Our increased understanding of disease pathogenesis is providing an ever-expanding arsenal of therapeutic options, but these can be expensive and patients can lose response or never respond to certain therapies. Therefore, there is now a growing need to personalise therapies on the basis of the underlying disease biology and a desire to shift our approach from “reactive” management driven by disease complications to “proactive” care with an aim to prevent disease sequelae. Precision medicine is the tailoring of medical treatment to the individual patient, encompassing a multitude of data-driven (and multi-omic) approaches to foster accurate clinical decision-making. In IBD, precision medicine would have significant benefits, enabling timely therapy that is both effective and appropriate for the individual. In this review, we summarise some of the key areas of progress towards precision medicine, including predicting disease susceptibility and its course, personalising therapies in IBD and monitoring response to therapy. We also highlight some of the challenges to be overcome in order to deliver this approach.

The Role of Diet in the Pathogenesis and Management of Inflammatory Bowel Disease: A Review

“…With improved technology we will be able to tailor an individual’s treatment based on specific factors, termed precision medicine. In IBD, factors such as diet, genetics, microbiome, clinical parameters and biomarkers will need to be considered in order to design the most effective treatment strategy [ 156 , 157 , 158 ]. Specific to diet, this approach has been demonstrated in a seminal paper, which explored diet in a generally healthy population.…”

Epigenetic Regulation of Glycosylation in Cancer and Other Diseases

“…IBD is a chronic inflammatory disorder that affects the gastrointestinal tract and comprises two clinical syndromes: Crohn’s disease (CD) and ulcerative colitis (UC) [ 135 , 136 ]. These diseases have unknown etiology, and there is insufficient information about pathogenesis, but it is believed that a complex interaction of genetic, epigenetic, microbial, environmental and immunological factors are involved [ 137 ]. In particular, several studies have evaluated the epigenetic status of IBD patients using candidate gene strategies [ 138 , 139 , 140 , 141 , 142 ] or epigenome-wide association studies [ 143 , 144 , 145 , 146 ], trying to elucidate IBD pathogenesis [ 147 ].…”

Current Developments of Clinical Sequencing and the Clinical Utility of Polygenic Risk Scores in Inflammatory Diseases

“…The most important factors underlying IBD pathogenesis can be summarized as genetics, environment, microbiome, and immunome (indicating the dysregulation of the immune response in the gut) ( 65 ). However, the genetic basis alone is extremely complex: The susceptibility variants identified mainly through GWAS explain only a fraction of the expected heritability and most risk loci contain several candidate genes.…”