Scientists at the University of Cambridge have developed a new test that can reliably predict the future course of inflammatory bowel disease in individuals, transforming treatments for patients and paving the way for a personalised approach.
Researchers at the Department of Medicine, University of Cambridge, and Cambridge University Hospitals NHS Trust previously showed that a genetic signature found in CD8 T-cells could be used to assign patients to one of two groups depending on whether their condition was likely to be mild or severe (requiring repeated treatment). However, isolating CD8 T-cells and obtaining the genetic signature was not straightforward, making the test unlikely to be scaleable and achieve widespread use.
In the latest study, published in the journal Gut, the researchers worked with a cohort of 69 patients with Crohn’s disease to see whether it was possible to develop a useful, scaleable test by looking at whole blood samples in conjunction with CD8 T-cells and using widely-available technology.1
The team used a combination of machine learning and a whole blood assay known as qPCR to identify genetic signatures that re-created the two subgroups from their previous study.
The researchers then validated their findings in 123 IBD patients recruited from clinics in Cambridge, Nottingham, Exeter and London.
“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,” says Dr James Lee, joint first author of the study.
“This is important as it could enable doctors to personalise the treatment that they give to each patient. 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.”
The accuracy of the test is comparable to similar biomarkers used in cancer, which have helped transform treatment, say the researchers. They found the new test was 90-100% accurate in correctly identifying patients who did not require multiple treatments.
- Biasci D et al. A blood-based prognostic biomarker in inflammatory bowel disease. Gut; April 2019;DOI:10.1136/gutjnl-2019-318343.