You may not have heard of biomarkers before, but they are a key part of managing your Crohn’s disease, ulcerative colitis, or indeterminate colitis (inflammatory bowel disease, or IBD).
Fecal Calprotectin: An IBD Biomarker Example
Biomarker means “biological marker.” They are important in understanding diseases, from diagnosis to treatment. For instance, one biomarker we are familiar with for IBD is fecal calprotectin. Calprotectin is a protein that’s found in stool (poop). When the level of calprotectin in the stool increases, it might mean the IBD is becoming active (which could be a flare-up).
We know this about fecal calprotectin because of testing. The level of fecal calprotectin in people who don’t have IBD are measured and compared to people with IBD who are at all stages of the disease process. Researchers can then understand what amount, or level, of fecal calprotectin, might mean a flare-up is starting or that one is in full swing.
One of the great things about fecal calprotectin is that it’s a measurement taken from stool. Providing a stool sample can be problematic for sure: some people may find it embarrassing or upsetting. But those difficulties aside, for some people it is a much easier way of understanding what is going on with the IBD than having a sigmoidoscopy or a colonoscopy.
The Future of IBD Biomarkers
We know that there are differences in the stool and blood of people with IBD as opposed to people without IBD. What if we could understand those differences better? Enough to know what differences and changes mean for the future and how the disease will behave?
We also know that there are many genes that are associated with IBD. What’s not entirely clear yet is which genes might mean that the IBD could be more likely, for instance, to cause fistulizing disease.
What if we could know these things?
This is what scientists and researchers like Dr Andres Hurtado-Lorenzo, Vice President of Translational research and IBD Ventures at the Crohn’s and Colitis Foundation are studying. Biomarkers in the blood, urine, stool, or from an ultrasound image might be easier to come by and give good information about how the IBD is behaving.
Types of Biomarkers
On Episode 121 of About IBD Podcast, Dr Hurtado-Lorenzo described the different types of biomarkers:
- Diagnostic biomarkers: Those that are used to diagnose a disease.
- Prognostic biomarkers: Those that are used to understand if a disease is in remission or is flaring.
- Predictive biomarkers: Those that can help understand if a treatment (or a drug) might work to treat a disease.
- Monitoring biomarkers: Those that can show if a treatment is actually working or not.
Having these types of biomarkers as tools could mean that we could understand which drug might work for best for which patients. This is called personalized or precision medicine, and while it is used for other conditions, we don’t yet have it for IBD.
How Biomarkers Might Change IBD
Dr Hurtado-Lorenzo went on to describe how having biomarkers for IBD might change how the disease is diagnosed, managed and treated. He outlined 4 ways in which this might happen:
- Diagnosis might be made quicker, less invasive, and more accurate
- Disease course (how the IBD changes over time) might be predictable, making it possible to find which patients might be at risk for worse outcomes
- Finding the right medicine to give to the right patient at the right time to give the best chance for remission
- Monitoring how the disease is changing over time in order to know how to tweak a treatment plan
The Big Unknowns
There is still much work to be done to understand biomarkers and how they can help people with IBD. There’s the research, of course, as well as the creation of the tests and then the work to bring them to regular use. Plus, in the United States, there’s the question of insurance coverage.
While there are still hurdles to overcome, Dr Hurtado-Lorenzo is optimistic that biomarkers might play a larger role in the management of IBD in the next decade. This is great news for us all, and especially as we see the incidence of IBD increasing around the world.
Ikhtaire S, Shajib MS, Reinisch W, Khan WI. Fecal calprotectin: its scope and utility in the management of inflammatory bowel disease. J Gastroenterol. 2016;51(5):434-446. doi:10.1007/s00535-016-1182-4