Proteomics and Imaging in Crohn's Disease: TAILS of Unlikely Allies. (February 2020) - Mainoli, Barbara
Abstract : Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease (IBD) that may be marked by debilitating symptoms of abdominal pain and obstruction. The etiology and pathogenesis of the disease are not fully understood, and treatment with corticosteroids, biologics, and surgical intervention are the usual therapeutic options. Diagnosis, disease activity, and therapeutic response are currently assessed by endoscopy, cross-sectional imaging, and biomarkers. However, challenges remain regarding the efficacy of the drugs and safety of these imaging techniques. There are also limitations with current clinical and laboratory tools for diagnosis, disease progression, and treatment response. Here, we discuss how the integration of proteomics and activity-based probes, along with intestinal ultrasound, an easily repeatable and well-tolerated diagnostic imaging modality, can address these challenges and may provide a novel precision medicine-based approach for the treatment of CD. Highlights: CD is a chronic inflammatory disease of the gastrointestinal tract that is heterogeneous in nature. Methods for diagnosis, selection of appropriate therapies, and monitoring efficacy of treatment in CD are currently inadequate. Current imaging techniques are often invasive, costly, and expose patients to high cumulative radiation. Given that visualization of CD needs to be performed often, these conventional methods add to a patient's burden of disease. Biomarkers available for the diagnosis of CD lack sensitivity and specificity. They have limited use and are not reliable. Physicians use them as indicators but must follow up with invasive endoscopies and cross-sectional imaging techniques to provide an accurate diagnosis and to phenotype disease behavior for therapy selection. Many studies have identified biomarkers of CD using proteomic tools; however, a clinical panel has yet to be developed. Methods to profile proteomes and proteolytic signatures in a systematic and unbiased manner are evolving and may help to improve outcomes for patients with CD through a precision-based approach.