Harnessing the Power of Precision Medicine and Novel Biomarkers to Treat Crohn's Disease

Abstract

Crohn's disease (CD) is a chronic inflammatory condition that affects the gastrointestinal tract. It is part of a spectrum of inflammatory Bowel Diseases (IBD). The disease is complex, characterized by significant inter and intra-individual heterogeneity, which contributes to a diverse and multifaceted portrayal of the disease. Consequently, applying specific and accurate treatment is challenging, and therapeutic success rates remain disappointing and insufficient. In recent years, significant advances in the therapeutic potential of CD have been made. Hope has been provided by these developments in the form of an expanding treatment toolkit. However, even with these beneficial adjustments, patients are frequently treated using an ineffective "one size fits all" treatment protocol, ultimately leading to a plateau in drug effectiveness and a decline in overall treatment success rates. Furthermore, with the advancement in the genome-wide association study, in combination with significant bioinformatic developments, the world of medicine has moved in the direction of personalized, tailored-treatment medicine, and this trend has not escaped the world of IBDs. Prediction models, novel biomarkers, and complex algorithms are emerging and inspiring optimism that CD patients will be treated with "precision medicine" in the near future, meaning that their treatments will be selected based on the patient's various unique features. In this review, we will outline the current diagnostic and therapeutic limitations that lead to a glass ceiling effect and thus send us in pursuit of discovering novel biomarkers. We will illustrate the challenges and difficulties in discovering relevant and innovative biomarkers and implementing them into everyday clinical practice. We will also heighten the progress made in practicing personalized medicine for CD patients and shed light on future directions and horizons.

Keywords: Crohn’s disease; GWAS; Inflammatory Bowel Diseases; biomarkers; microbiome; multi-omics; patient stratification; precision medicine; therapeutic goals.

Figure 1

IBD is a multifactorial disease, arising from a complicated interplay between many factors, including genetics, epigenetics, disorders in the immune system, the microbiome, external environmental triggers, and more. All these variables can serve as future potential biomarkers, aiding in diagnosis and prognostication.

Figure 2

A schematic diagram depicting the current and future potential, multilayered, ‘state-of-the-art’ biomarkers utilized in IBD, categorized by origin and source of the biomarker.