Crohn’s disease and ulcerative colitis are increasingly common, chronic forms of inflammatory bowel disease which predominantly affect young adults. The behaviour of these diseases varies from one patient to the next, making it difficult to identify which type of treatment would be most effective for an individual patient.
Currently, a ‘step-up’ management strategy is used, combining escalating quantities of immunosuppression drugs with other therapies. Using such an aggressive course of treatment can be helpful for those with serious forms of the diseases, but the side-effects of immunosuppression therapies can be so severe that treatment does more harm than good for those with milder forms of the diseases.
Professor Ken Smith of the Department of Medicine at the University of Cambridge, along with colleagues from the Cambridge Institute for Medical Research, have identified a T-cell signature which can predict prognosis for both diseases, enabling clinicians to determine the most effective treatment plan at the point of diagnosis.
In a study of 35 patients with active Crohn’s disease and 32 patients with active ulcerative colitis, Professor Smith and his colleagues identified a specific signature (IBD1), which was present in patients with relapsing or chronically active forms of both diseases, while a different signature (IBD2) was present in those with less serious forms of the diseases.
Additionally, there was such a significant overlap in the gene signatures between both diseases, which are otherwise medically distinct from one another, that they could be used interchangeably for both diseases.
The findings suggest that the diseases are influenced by common pathways and identify what likely to be the first practical biomarker which can predict prognosis in either condition. Clinical trials are expected to begin in 2012.
The paper, Gene expression profiling of CD8+ T cells predicts prognosis in patients with Crohn disease and ulcerative colitis, was published recently in the Journal of Clinical Investigation.
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Photo credit: Chronic ulcerative colitis, by euthman on FlickrTags: biomarker signature, CIMR, crohns disease, gene expression, genes, immunosuppression, inflammatory bowel disease, ken smith, ulcerative colitis