Patent Application
20240103008
This invention relates to methods for the detection and treatment of inflammatory bowel disease, in particular ulcerative colitis and Crohn's disease.
Treatment of inflammatory bowel diseases (IBD) can be improved by the ability to identifying biomarkers, allowing the optimization of therapeutic dose and understand response. While molecular characterization from diseased tissues coupled with clinical measures of IBD response has identified patient pathotypes, enabling future tailoring of treatments to disease-driving mechanisms is still required. Most existing clinical datasets do not pair gut and peripheral samples and focus on well-defined IBD populations. Therefore, the generation of content-rich data sets from heterogeneous IBD populations is an outstanding effort worth pursuing.
The present disclosure provides matched gut and peripheral biomarkers to assess, identify and improve therapeutic measures for IBD, in particular ulcerative colitis and Crohn's disease. In some embodiements, disclosure provides a method for identifying and assessing the severity of Crohn's disease by measuring the gene expression of biomarkers in the blood and gut, in particular from colon and/or ileum, wherein the biomarker is selected from:
In one embodiment, the disclosure provides a method for treating IBD in a patient suffering from or at risk of IBD, said method comprising: obtaining a sample of blood of the patient and measuring gene expression of biomarkers in blood; obtaining a tissue sample from said patient's gut and measuring gene expression of one ore more biomarkers selected from the lists above and administering a therapeutic agent for the treatment of IBD.
The present disclosure provides matched gut and peripheral biomarkers to assess, identify and improve therapeutic measures for IBD, in particular ulcerative colitis and Crohn's disease. In some embodiements, disclosure provides a method for identifying and assessing the severity of Crohn's disease by measuring the gene expression of biomarkers in the blood and gut, in particular from colon and/or ileum, wherein the biomarker is selected from:
In one embodiment, the disclosure provides a method for treating IBD in a patient suffering from or at risk of IBD, said method comprising: obtaining a sample of blood of the patient and measuring gene expression of biomarkers in blood; obtaining a tissue sample from said patient's gut and measuring gene expression of one ore more biomarkers selected from the lists above and administering a therapeutic agent for the treatment of IBD. In some embodiments, IBD is selected from Crohn's disease and ulcerative colitis. In some embodiments, the expression of biomarker is measured in the sample is at least about 10% of expression of said biomarker measured in a control sample from a subject not suffering from Crohn's disease. In some ebmodiments, the therapeutic agent is selected from the group consisting of: a vitamin supplement, an anti-inflammatory, a corticosteroid, a 5-aminosalicylate, an immunosuppressant, azathioprine, mercaptopurine, an anti-TNF-α antibody, infliximab, adalimumab, certolizumab pegol, methotrexate, an anti-α 4-integrin antibody, natalizumab, vedolizumab, an anti-interleukin antibody, ustekinumab, an antibacterial antibiotic, ciprofloxacin, and metronidazole. In some embodiments, the therapeutic agent is selected from the group consisting of: vitamin B12, vitamin D, calcium, certolizumab pegol, methotrexate, and natalizumab.
In one embodiment, provided is a method of predicting a response of a subject diagnosed with an IBD to an anti-interleukin (IL) treatment of the IBD, the method comprising: contacting a sample from a subject with a set of probes capable of detecting a panel of biomarkers selected from the group the list above; and determining a pattern of the panel of biomarkers; wherein the pattern of the panel of biomarkers predicts the response to the anti-IL treatment in the subject.
In some embodiments, the anti-inflammatory treatment provided herein is an anti-tumor necrosis factor (TNF) treatment, a JAK inhibitor (JAKi) treatment, or an anti-interleukin (IL) treatment. In some embodiments, the anti-inflammatory treatment is an anti-IL-23 or anti-IL-12/23 treatment. In other embodiments, the anti-IL treatment is ustekinumab. In some embodiments, the anti-inflammatory treatment is the JAK inhibitor treatment. In other embodiments, the anti-inflammatory treatment is the anti-TNF treatment. In some embodiments, the anti-TNF treatment is golimumab.
In some embodiments, the anti-inflammatory treatment provided herein for the method of treating the subject diagnosed with IBD, is an anti-tumor necrosis factor (TNF) treatment, a JAK inhibitor (JAKi) treatment, or an anti-interleukin (IL) treatment. In some embodiments, the anti-inflammatory treatment is an anti-IL-23 or anti-IL-12/23 treatment. In other embodiments, the anti-IL treatment is ustekinumab. In some embodiments, the anti-inflammatory treatment is the JAK inhibitor treatment. In other embodiments, the anti-inflammatory treatment is the anti-TNF treatment. In some embodiments, the anti-TNF treatment is golimumab.
In another aspect, the kit provided herein comprises a set of isolated probes capable of detecting one or more biomarkers selected from Table A:
In another aspect, the kit provided herein comprises a set of isolated probes capable of detecting at least five, preferably ten, or more preferably fifteen or twenty or twenty five or thirty, or more biomarkers selected from Table A.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this invention pertains. Otherwise, certain terms used herein have the meanings as set forth in the specification.
It must be noted that as used herein and in the appended claims, the singular forms “a,” “an,” and “the” include plural reference unless the context clearly dictates otherwise.
Unless otherwise indicated, the term “at least” preceding a series of elements is to be understood to refer to every element in the series. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the invention.
As used herein, the terms “comprises,” “comprising,” “includes,” “including or any other variation thereof, will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers and are intended to be non-exclusive or open-ended. For example, a composition, a mixture, a process, a method, an article, or an apparatus that comprises a list of elements is not necessarily limited to only those elements but can include other elements not expressly listed or inherent to such composition, mixture, process, method, article, or apparatus. Further, unless expressly stated to the contrary, “or” refers to an inclusive or and not to an exclusive or. For example, a condition A or B is satisfied by any one of the following: A is true (or present) and B is false (or not present), A is false (or not present) and B is true (or present), and both A and B are true (or present).
It should also be understood that the terms “about,” “approximately,” “generally,” “substantially” and like terms, used herein when referring to a dimension or characteristic of a component of the preferred invention, indicate that the described dimension/characteristic is not a strict boundary or parameter and does not exclude minor variations therefrom that are functionally the same or similar, as would be understood by one having ordinary skill in the art. At a minimum, such references that include a numerical parameter would include variations that, using mathematical and industrial principles accepted in the art (e.g., rounding, measurement or other systematic errors, manufacturing tolerances, etc.), would not vary the least significant digit.
The term “expressed” or “expression” as used herein refers to the transcription from a gene to give an RNA nucleic acid molecule at least complementary in part to a region of one of the two nucleic acid strands of the gene. The term “expressed” or “expression” as used herein also refers to the translation from the RNA molecule to give a protein, a polypeptide, or a portion thereof.
As used herein, “biomarker” refers to a gene or protein whose level of expression or concentration in a sample is altered compared to that of a normal or healthy sample or is indicative of a condition. The biomarkers disclosed herein are genes and/or proteins whose expression level or concentration or timing of expression or concentration correlates with the prognosis of an inflammatory bowel disease, in particular, ulcerative colitis and/or Crohn's disease.
The term “administering” with respect to the methods of the invention, means a method for therapeutically or prophylactically preventing, treating or ameliorating a syndrome, disorder or disease (e.g., an inflammatory bowel disease (IBD)) as described herein. Such methods include administering an effective amount of said therapeutic agent at different times during the course of a therapy or concurrently in a combination form. The methods of the invention are to be understood as embracing all known therapeutic treatment regimens.
The term “effective amount” or “therapeutically effective amount” means that amount of active compound or pharmaceutical agent, a combination of therapeutic compounds or pharmaceutical compositions thereof provided herein, that elicits the biological or medicinal response in a tissue system, animal or human, that is being sought by a researcher, veterinarian, medical doctor, or other clinician, which includes preventing, treating or ameliorating a syndrome, disorder, or disease being treated, or the symptoms of a syndrome, disorder or disease being treated (e.g., IBD).
Endoscopic biopsies were obtained from 39 Crohn's disease (CD) patients, 59 Ulcerative colitis (UC) patients, and 15 non-IBD donors from multiple matched colon and ileum sites (
Raw reads were aligned to the human genome with STAR aligner. Gene level counts data was generated using RSEM. Statistical analysis of differential gene expression was performed on transcriptome and proteome from gut and peripheral samples, using linear regression model (LIMMA package in R). Between sample normalization was performed using EgdeR TMM, followed by linear modeling of gene expression using limma/voom workflow to identify differentially expressed genes. Coexpression analysis was performed using Weighted Gene Coexpression Network Approach (WGCNA) on top 11,000 differentially expressed genes to identify disease phenotype.
Transcriptomic disease profiles were identified from tissue and blood (
Unbiased LCMS identified expression of 7000 proteins in the tissue biopsies (
800 proteins were detected in blood using an unbiased LCMS proteomics approach. The upregulated DEPs were involved in Neutrophil/Granulocyte migration while the downregulated DEPS were involved in collagen binding. These results were confirmed using in independent proteomics platform (SomaScan®, SomaLogic).
The DEGs from the BMS IBD cohort clustered into 18 modules. Modules divided into three groups: 1) the more severe the disease the more enriched (7 modules—green box), 2) the less severe the more enriched (8 modules—orange box) and 3) no enrichment difference across severities.
Looking at the BMS IBD module enrichments in the GSE16879 data sets (bottom) we observe that: 1) many modules change in R only when comparing baseline to PostTr, 2) most of the modules show a differential enrichment at baseline between R and NR and 3) some modules show differences at baseline between R and NR such as innate immune
We identified shared markers in tissue and blood allowing for development of a common signature (BMS_IBD_T-B) which tracks with clinical severity of colon biopsies (
The BMS_IBD_T-B signature in blood better distinguishes clinical disease severity compared to GIMATS (Reference: Martin J, Chang C, Boschetti G et al. Single-Cell Analysis of Crohn's Disease Lesions Identifies a Pathogenic Cellular Module Associated with Resistance to Anti-TNF Therapy. Cell. 2019 Sep. 5; 178(6): 1493-1508) or the PredictSure blood test (Biasci D, Lee J, Noor N et al. A blood-based prognostic biomarker in IBD. Gut 2019;68:1386-1395) while having a comparable performance in tissue (
The BMS_IBD_T-B signature in tissue has similar enrichment scores as the mature DC and neutrophil signatures in tissue (
In blood the best disease severity correlated signatures other than the BMS_IBD_T-B signature are also the Mature DC and Neutrophil signatures while no other cell signature show a disease severity correlated enrichment.
This application claims the benefit of U.S. Provisional Application Ser. No. 63/409,970 filed Sep. 26, 2022 which is incorporated herein in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63409970 | Sep 2022 | US |
