Treatment options for inflammatory bowel disease (IBD) have been limited for most of Elisa Boden, MD’s career. Until a few years ago, she and her colleagues – including James Lord, MD, PhD, and Michael Chiorean, MD – have had only a few types of medications to treat IBD. And those drugs often failed to stop the immune attacks that trigger the two forms of IBD: Crohn’s disease and ulcerative colitis.
“Only about half of IBD patients respond to those drugs – and only about 20 percent achieve remission,” says Dr. Boden, a gastroenterologist at the Virginia Mason Digestive Disease Institute and a principal investigator at the Benaroya Research Institute at Virginia Mason (BRI). “Unfortunately, this leaves many IBD patients to endure incessant digestive problems, severe pain and other symptoms that can erode their quality of life.”
The good news is that IBD treatment options are rapidly expanding and an unprecedented number of new therapies are in clinical trials. But there’s no way to predict which one will work for a particular patient. Instead, doctors must follow a ‘trial and error’ approach, and it can take months before they find the right therapy.
That’s why Drs. Boden, Lord and Chiorean are working to revolutionize IBD treatment by pursuing a precision medicine approach that could tailor treatment to individual IBD patients. They are performing research to identify biomarkers – proteins and other molecules in patients’ blood or cells – that can predict whether they respond to a specific drug.
“The vision is that doctors could use advanced tests to pinpoint a patient’s biological profile as soon as they’re diagnosed, and then match them with the right therapy,” Dr. Lord says. “This means patients could almost immediately get the treatment that gives them the best shot at success, without having to endure symptoms or get worse while we search for the right drug.”
Drs. Boden and Lord reached a key milestone last year, when they published their discovery of a biomarker that could potentially identify which patients respond to the drug vedolizumab.
The researchers started this study by taking blood samples from IBD patients before they started using vedolizumab, and then again after they had taken several doses. Dr. Lord’s lab then carefully analyzed the immune cells in these samples.
Vedolizumab binds to a type of receptor on some immune cells. Drs. Boden and Lord discovered that some people who have more of this receptor on the outside of their cells respond better to the drug.
Now Drs. Boden and Lord are running a study to confirm their results.
“This could eventually open the door to a clinical test that could predict which patients should receive vedolizumab,” Dr. Boden says.
Why Biorepositories Matter
The vedolizumab study is just one example of how Drs. Boden and Lord are investigating biomarkers related to new IBD therapies. IBD patients at Virginia Mason have the option to participate in a BRI biorepository. Dr. Lord’s lab studies the cells in these samples to identify differences between people who respond well to a therapy and people who don’t.
“We’re extremely grateful for people who donate these samples, because it gives us what we need to study the IBD biomarkers, and to investigate many other pivotal questions,” Dr. Lord says.
As this research progresses, Dr. Lord envisions developing a “menu” of biomarkers that physicians can use to determine which therapies are right for which IBD patients.
The fact that patients respond differently to different treatments suggests there are several forms of IBD. Discovering biomarkers that can differentiate these forms of IBD might reveal what happens in different people. More importantly, the research could help uncover ways to rebalance the immune system when it turns against people to cause IBD.
“I think there’s a realistic chance we’ll cure some forms of IBD in my lifetime,” Dr. Lord says.
Creating a Brighter Future
Celeste Gracey started having bleeding, irregularity and intense stomach pains in her late teens. It took 10 years before doctors solved the mystery and diagnosed her with inflammatory bowel disease.
Now Dr. Chiorean is helping her manage her illness, and Celeste’s journey inspired her to volunteer in Dr. Lord’s lab – and to pursue a career as a physician. She helped Dr. Lord with key tasks on the vedolizumab study, like capturing images of cells. Playing a small role in this research makes her optimistic about the next generation of IBD treatments.
“I feel like, someday, I could walk into a doctor’s office, sicker than I was before, and know that a medication will or won’t work for me because of this research,” she says.
She recently finished her medical school prerequisites and applications, all while raising two kids. As a mother who knows that autoimmune diseases are genetic, Celeste sees BRI’s work creating a brighter future for her family.
“BRI’s research gives me hope that if my kids do get an autoimmune disease, they’ll be able to control it and live really productive lives – they won’t have to suffer like I did,” she says.
Originally published in BRING IT ON newsletter - Summer 2019
May 31, 2019
Like What You Read?
Stay informed! Be sure you receive regular research updates. Subscribe
Join the Conversation
This blog does not provide medical advice, nor is it a substitute
for professional medical advice, diagnosis or treatment.