Researchers have developed a new test that can predict the severity of inflammatory bowel disease. The test will help allow for more personalized treatment plans in the future.

Inflammatory bowel disease (IBD) is the term that doctors use to describe chronic inflammation of the gastrointestinal tract. According to the Centers for Disease Control and Prevention (CDC), 1.3% of adults in the United States have IBD. Types of IBD include Crohn's disease, which involves the lining of the digestive tract, and ulcerative colitis, which affects the lining of the large intestine and rectum.

The symptoms of Crohn's disease and ulcerative colitis may vary, depending on the severity of inflammation, but they usually involve diarrhea, abdominal pain, fatigue, and weight loss.

Various medicines can treat the symptoms of IBD and stop its reoccurrence, but there is currently no cure. The more severe the inflammation is, the more powerful the drugs need to be, and some of these medications can have unpleasant side effects. For this reason, researchers are keen to find ways to predict how the course of the disease will progress to guide treatment options. To date, however, this has not been possible.

Developing a new prognostic test

Previously, researchers in Cambridge in the United Kingdom demonstrated the potential to use a genetic signature in CD8 T cells—a type of immune cell—to predict the severity of IBD. However, a test was not practical because isolating CD8 T cells and identifying the signature was complex.

Following on from this, scientists at the University of Cambridge focused on developing a test using the CD8 T cell signature, but with readily available technology. The researchers, who have published their findings in the journal Gut, used a mix of machine learning and a whole-blood assay they call qPCR.

By using qPCR, which is a commonplace health-care tool in hospital labs in the United Kingdom, they could identify genetic signatures and ascertain whether someone's IBD would be mild or severe. Once the test was ready, the scientists confirmed their findings in more than 120 people with IBD from across the United Kingdom.

Dr. James Lee, who is the joint first author of the study, explains how straightforward the process could prove.

"Using simple technology that is available in almost every hospital, our test looks for a biomarker—essentially, a medical signature—to identify which patients are likely to have mild IBD and which ones will have more serious illness."

—Dr. James Lee

Continuing, Dr. Lee says, "If an individual is likely to have only mild disease, they don't want to be taking strong drugs with unpleasant side effects. But, similarly, if someone is likely to have a more aggressive form of the disease, then the evidence suggests that the sooner we can start them on the best available treatments, the better we can manage their condition."

Shifting from a 'one size fits all' approach

The researchers say that the test compares to biomarkers for cancer, which have contributed to the creation of new treatments. A company co-founded by professor Ken Smith, senior author of the study, with support from Cambridge Enterprise, a branch of Cambridge University, is now focusing on developing the new test further.

"IBD can be a very debilitating disease, but this new test could help us transform treatment options, moving away from a 'one size fits all' approach to a personalized approach to treating patients," said Smith.

Helen Terry, director of research at Crohn's & Colitis UK, welcomed the new approach as "really exciting." She explains that the latest study is the accumulation of a decade of medical research and could "drastically change" the lives of people with IBD.

The research team also illustrates the relevance of its work with a case study that shows how one individual would have benefited from the new prognostic test and a more personalized approach. A 31-year-old woman received a Crohn's disease diagnosis when she was 14 years old. She underwent bowel resection, but symptoms returned. Different medications failed, and she had drug side effects that led to more admissions to the hospital. With a badly damaged bowel, the patient needed another surgical procedure when she was 20 years of age, which was followed by more drug treatment. The Cambridge researchers believe that a prognostic test would have allowed the woman to be more aware of her disease's likely course, and it would have allowed her to try stronger treatments earlier.