Optimal choice of targeted therapies in inflammatory bowel disease
Research type
Research Study
Full title
Optimal choice of targeted therapies in inflammatory bowel disease by using optical diagnosis colonoscopy and probe confocal laser endomicroscopy along with molecular and cellular characteristics of inflamed intestinal mucosa.
IRAS ID
227882
Contact name
Marietta Iacucci
Contact email
Sponsor organisation
University of Birmingham ,UK
Duration of Study in the UK
4 years, 0 months, 0 days
Research summary
Summary of Research
Optimizing outcomes in IBD requires rapid and sustained control of the inflammation. As new therapies are introduced treatment is moving beyond symptoms and more to objective treat-to-target paradigm where the target is control of inflammation. While monoclonal antibodies targeted against TNF, α4β7 integrins and IL-12/23p40 have made significant impact in IBD, the efficacy of individual agents is modest and failure rate is high. Using novel endoscopic technique such as Electronic virtual Chromoendoscopy (ECV) and probe confocal laser endomicroscopy (pCLE) may permit us to assess in real time the important therapeutic goal of response to therapy and achievement of mucosal healing and histological healing in IBD more precisely which may be of prognostic importance. Molecular imaging is based on the utilization of fluorescent probes with specificity toward defined molecular targets and their visualization by endoscopic devices such as confocal laser endomicroscopy (CLE). The potential use of molecular imaging is to stratify of IBD patients regarding response to targeted antibody therapy. The concept of tailoring therapy to individual patients based on molecular analysis could help to maximize benefits and minimize risks.
Summary of Results
We enrolled 29 patients with Ulcerative Colitis and Crohn’s Disease who were due to start biologic therapy. Prior to starting treatment, patients underwent evaluation of the intestine with a colonoscopy and confocal laser probe. Targeted biopsies were taken to assess the expression of predictive response therapy genes.
Our results show that microscopic alterations of the intestine and mucosal binding drugs assessed with this confocal leaser endomicroscopy probe can predict response to therapy accurately.
Our predictive intestinal endoscopic features and gene markers can improve treatment choice, reducing the time to achieve disease control while sparing side effects and the cost of ineffective therapy. Furthermore, we have identified seven specific novel future therapy targets.REC name
HSC REC A
REC reference
17/NI/0148
Date of REC Opinion
1 Aug 2017
REC opinion
Favourable Opinion