567Biomarkers of IBD
In 2012, Genisphere and the Lankenau Institute for Medical Research expanded
their research collaboration covering miRNA biomarkers for ulcerative colitis to
include Crohn’s disease and other IBDs. The partners will use the Affymetrix
GeneChip miRNA Array to identify the miRNA biomarkers. The goal is to identify
biomarker panels that can classify the various forms of IBD and develop a diagnos-
tic test to shed light on how patients are being correctly or incorrectly diagnosed in
their respective diseases and to provide information on how they are responding to
treatment. This will enable personalized treatment of IBD.
Chromosome 16 and the HLA region on chromosome 6 have been implicated in
susceptibility to Crohn’s disease. Mutations in the NOD2/CARD15 gene, identifi ed
on chromosome 16, have been associated with Crohn’s disease overall, but are
found in only 25 % of patients. The clinical pattern of Crohn’s disease may be
defi ned by specifi c genotypes. Advancement of genome analysis might have an
impact on the treatment of infl ammatory bowel diseases. Genomic studies have
revealed some genetic factors contribute to pathogenesis of IBD such as HLA, IL4,
MUC3, IBD1 locus, IBD2 locus. More information about genes concerning IBD
will be provided by analyzing dense SNP map using DNA tip. They will open the
way to personalized therapy of IBD.
Personalized Approaches to Management of IBD
There are few proven examples of the importance of pharmacogenetics of serotonin-
modifying agents used in functional gastrointestinal or motility disorders. Genetic
variations in transporters and translation mechanisms have been associated with
responses to treatment in IBD (Camilleri 2007 ). Research on the impact of poly-
morphisms of key proteins on the pharmacokinetics and pharmacodynamics of
drugs that alter serotonin-mediated signaling will assist in explaining diverse
responses to those drugs and ultimately improve personalized approach to IBD.
Personalized approach to management of IBD is evolving along with develop-
ment of new therapies. MAbs directed against TNF, in combination with immuno-
suppressive drugs, are effective in high-risk patients if initiated early in the course
of IBD. Therapy of IBD can be optimized by appropriate pretreatment testing and
patient-based monitoring strategies (Mosli et al. 2014 ). Although most patients
respond to ant-TNF therapy, some do not respond or lose response to the drug over
time, which can be caused by patient, TNF-inhibitor, or disease-related factors infl u-
encing the pharmacokinetics and pharmacodynamics of the drug. Therefore, target
concentration adjusted dosing by therapeutic drug monitoring, may help to guide
therapeutic decisions in line with concepts of personalized medicine (Vande Casteele
et al. 2014 ). Algorithms for the management of patients with IBD require a person-
alized approach incorporating likely natural course of the disease in the individual
patient, a strategy for management of loss of response to current therapies, and
probability of response to a specifi c therapeutic agent (Ananthakrishnan 2013 ).
Personalized Management of Gastrointestinal Disorders