Study researchers Jean-Frédéric Colombel, MD, and Joana Torres, MD, postdoctoral fellow, Department of Medicine (Gastroenterology)
Years before inflammatory bowel disease (IBD) is diagnosed and symptoms exist, biomarkers are already circulating that can help predict risk not only of disease development but also of complications, according to recent findings by Mount Sinai scientists and partner organizations. For the first time, researchers found that these markers, in the form of antimicrobial antibodies, were present in serum up to six years before diagnosis of IBD, and that the higher number of antibodies indicated a greater chance of complications at or around the time of diagnosis.
The results of the study, known as PREDICTS (Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects), were published June 15, 2016, in Alimentary Pharmacology & Therapeutics. Study partners included the Naval Medical Research Center, Mayo Clinic, Prometheus Laboratories, and Janssen pharmaceuticals.
“This study adds an additional piece of evidence into ‘life before IBD,’ a major focus of research at Mount Sinai, since exploring the preclinical phase of inflammatory bowel disease may offer some new insights into disease origin and even prevention,” says Jean-Frédéric Colombel, MD, co-senior author and Co-Director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. An estimated two million people in the United States have IBD, a lifelong illness marked by swelling and irritation of the intestines.
“IBD is a progressive disease, and by the time it is diagnosed, one-third of patients present with complications, which may involve abscesses, strictures, or the need for surgery,” Dr. Colombel says. “Our findings could ultimately lead to the development of a tool to detect the disease before the first clinical manifestations so that we could apply preventive strategies.”
Those strategies, for example, could include changing the diet and manipulating the gut microbiome, which is the largest microbial community in the human body, in a family with children considered at high risk for developing the disease, says Dr. Colombel, an internationally renowned IBD clinician and researcher who is also Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai.
Clinical data from the Defense Medical Surveillance System, and serum samples from the U.S. Department of Defense serum repository, made the PREDICTS study possible. From the medical information of more than seven million members of the U.S. armed forces, researchers identified patients with a diagnosis of Crohn’s disease, a major form of IBD. They then retrieved up to four pre- and post-diagnostic serum samples from each patient, making this the first longitudinal assessment showing these markers and their progression using multiple samples at different time points before diagnosis. According to the results, 65 percent of patients tested positive for at least one marker in the earliest serum samples, and the number of positive markers increased up to diagnosis.
In the months ahead, investigators will expand the study to look for preclinical biomarkers beyond antimicrobial antibodies, which could include proteomics and infectious agents like viruses in the serum of patients.