Inflammatory bowel disease, or IBD, is a chronic intestinal disorder caused by a dysfunctional immune system that mistakenly attacks intestinal tissues when fighting foreign pathogens, resulting in mucosal tissue destruction and increased extracellular matrix (ECM) remodeling. Inflammatory bowel diseases are commonly divided into Crohn's disease and ulcerative colitis.
Crohn's disease and ulcerative colitis are characterized by inflammation of the mucosa with increased protease activity, leading to increased remodeling of the extracellular matrix and increased deposition of collagen in the lamina propria and submucosa. Excessive collagen deposition in the intestinal mucosa and unresolved inflammation are the main causes of surgery in IBD patients due to inadequate response to treatment. Therefore, extracellular matrix markers are important for monitoring mucosal healing/intestinal healing and predicting response to treatment.
How many people have inflammatory bowel disease?
More than 7 million people are currently diagnosed with inflammatory bowel disease, with a prevalence of approximately 0.3% worldwide. Risk factors also include age, genetics, smoking status, obesity and environmental factors.
How is inflammatory bowel disease treated?
There is no cure for IBD, but the symptoms and inflammation can be treated with immunosuppressants, steroids, or synthetic or biologic medications. The type of treatment depends on the severity of symptoms, the location of the disease, and the number of years with IBD.
How is inflammatory bowel disease diagnosed?
There is no single reference standard for diagnosing Crohn's disease or ulcerative colitis. Diagnosis of Crohn's disease or ulcerative colitis is based on a combination of clinical, biochemical (CRP and fecal calprotectin), stool-based, endoscopic, imaging, and histologic studies.
The medical need for IBD biomarkers today is twofold. First, the diagnosis remains challenging because the signs and symptoms mimic those of many other diseases, including Crohn's disease and UC. Therefore, distinguishing between ulcerative colitis and Crohn's disease is difficult. Current biomarker techniques are inaccurate and have difficulty determining patients' future prognoses.
Moreover, despite great progress in the availability of new and effective drugs in recent decades, there is still a significant proportion of patients who do not respond to treatment or whose efficacy declines over time. Nordic biomarkers have the potential to greatly benefit drug development by assisting in the early diagnosis of disease and initiating the most appropriate treatment at the right time, as well as monitoring mucosal healing:
In addition, the use of Nordic's biomarkers to enrich or stratify patients more likely to experience mucosal healing and treatment response in drug development trials may reduce the duration and size of studies needed to determine therapeutic efficacy.
Inflammatory bowel disease is characterized by chronic recurrent inflammation leading to progressive mucosal destruction and remodeling of the extracellular matrix. The Nordic ProteinFingerPrint Technology™ can be used to quantify the degree of inflammation, mucosal damage, and intestinal fibrogenesis by quantifying fragments of protease-mediated degradation of essential mucosal tissue proteins, including a novel serum calprotectin biomarker (CPa9-HNE) and collagen-derived biomarkers (e.g., C3M, PRO-C3, C4M) released into the bloodstream. This serum calprotectin biomarker eliminates the need of fecal samples, greatly increasing patient compliance and ease of sampling.
The extracellular matrix of the intestinal mucosa is mainly composed of collagen, laminin and elastin. The intestinal tissue is a high turnover tissue, which means that the epithelium is replaced once a week. Extracellular matrix remodeling is essential for intestinal tissue homeostasis. However, if extracellular matrix remodeling is constantly altered and out of balance, tissue homeostasis will be compromised, resulting in severe tissue destruction and ineffective healing.
In IBD, the balance of extracellular matrix remodeling is imbalanced due to high protease activity and increased deposition of extracellular matrix, leading to increased mucosal destruction and initiation of repair processes, which in turn result in scarring of the intestinal mucosa and intestinal fibrosis.
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CPa9-HNE is suppressed in IBD patients in remissions compared to IBD patients with active disease. Thus high serum levels of CPa9-HNE reflect disease activity.
While fecal calprotectin remains one of the best diagnostic biomarkers for distinguishing IBD from IBS, the ability of fecal calprotectin and CRP to predict response to treatment is limited. Therefore, there is still a need in medicine and drug development for biomarkers that are able to characterize and quantify structural mucosal changes and predict disease progression and response to treatment.
Nordic ProteinFingerPrint Technology™ biomarkers measured in serum are generally increased in ulcerative colitis and Crohn's disease patients compared to healthy subjects (HS).
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Nordic ProteinFingerPrint Technology™ biomarkers measured in serum are associated with established disease activity parameters, including SES-Crohn's disease (Crohn's disease endoscopic score) and mMES (ulcerative colitis endoscopic score), generally increased in ulcerative colitis and Crohn's disease patients compared to healthy subjects.
Correlations between baseline biomarkers concentrations and clinical disease activity parameters.
Nordic ProteinFingerPrint Technology™ biomarkers allow pharmacodynamic profiling of novel treatments by measuring protein degradation fragments directly in a serum sample.
Reference: Mortensen et al 2020 JCG.
Asterisks (*) depictsignificant differences from baseline. Squares (#) depictssignificant difference betweenresponders and non-responders
Early suppression in the Nordic ProteinFingerPrint Technology™ biomarker VICM provides and information on target engagement and monitoring of treatment response.
Low baseline serum levels of the Nordic ProteinFingerPrint Technology™ biomarker, C4M, predicts response to efficacious treatment. The response is defined as being in clinical remission assessed with the HBI (Crohn's disease clinical disease activity score).
Reference: Haaften et al 2020 CTG.
Baseline prediction of anti-TNFα (IFX and ADA) clinical response with Nordic ProteinFingerPrint Technology™ biomarker C4M.
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