Predicting response to anti-TNF treatment in perianal Crohn’s disease using gene expression data
Lead Researcher: Dr Domenico Cozzetto
Supported by the Digestive Diseases Theme
Crohn’s disease (CD) is a common gut condition affecting millions of patients worldwide and is especially common in the UK. Over time CD patients develop complications, including perianal CD (pCD), where abnormal tunnels (called “fistulas”) burrow from the back passage to other areas of the body, such as the skin around the bottom, the vagina or bladder. Fistulas cause pain, discharge of pus, infection, and faecal incontinence. Patients with perianal CD (pCD) experience depression/anxiety (>70%) and poor quality of life.
Several different drugs are used in pCD, but there is no way of knowing which drug will work in which patient, leaving many patients languishing with ongoing symptoms and irreversible complications, including surgery, such as a permanent “bag” (stoma) on the outside of the abdomen. A new approach termed “precision medicine” heralds an exciting new era – selecting personalised treatments based on novel tests that can be used to predict how patients will respond to drug treatment. Precision medicine is a key research priority for patients and a main component of Imperial’s BRC Digestive Diseases theme. This project builds on extensive preliminary data from our lab with the aim of bringing new precision medicine opportunities into the clinic for pCD. We have developed a new test that predicts which CD patients will respond to the most used drug. Which counteracts the function of the signalling protein called TNF. This study validates whether this test can predict response to anti-TNF treatment, specifically in patients with pCD by taking advantage of the UK-wide study called GONDOMAR, which has been recruiting patients with pCD about to start anti-TNF treatment at 40 different hospitals.
Realising the potential of precision medicine and developing a new “predictive” test will revolutionise outcomes for patients with pCD, enabling individual patients to be fast-tracked to the right drug at the right time, reversing the bleak outlook for so many patients.