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利用精准医学和新型生物标志物的力量治疗克罗恩病。

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

作者信息

Kriger-Sharabi Ofra Aviva, Kopylov Uri

机构信息

Department of Gatsroenterology, Assuta Ashdod Medical Center, Affiliated to The Ben-Gurion University (BGU) Medical School, Ashdod 7747629, Israel.

Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Affliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.

出版信息

J Clin Med. 2023 Apr 4;12(7):2696. doi: 10.3390/jcm12072696.

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.

摘要

克罗恩病(CD)是一种影响胃肠道的慢性炎症性疾病。它是炎症性肠病(IBD)谱系的一部分。该疾病较为复杂,个体间和个体内存在显著异质性,这使得对该疾病的描述多样且具有多面性。因此,应用特定且准确的治疗具有挑战性,治疗成功率仍然令人失望且不足。近年来,CD的治疗潜力取得了重大进展。这些进展以不断扩大的治疗工具包的形式带来了希望。然而,即使有这些有益的调整,患者仍经常采用无效的“一刀切”治疗方案,最终导致药物疗效停滞不前,整体治疗成功率下降。此外,随着全基因组关联研究的进展,结合重大的生物信息学发展,医学领域已朝着个性化、量身定制的治疗医学方向发展,这种趋势也影响到了IBD领域。预测模型、新型生物标志物和复杂算法不断涌现,让人乐观地认为CD患者在不久的将来将接受“精准医学”治疗,即根据患者的各种独特特征选择治疗方案。在这篇综述中,我们将概述导致瓶颈效应的当前诊断和治疗局限性,从而促使我们去寻找新型生物标志物。我们将阐述发现相关和创新性生物标志物并将其应用于日常临床实践中的挑战和困难。我们还将强调在为CD患者实施个性化医学方面取得的进展,并阐明未来的方向和前景。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6354/10094767/fa0cc602a6f1/jcm-12-02696-g001.jpg

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