Arie Levine © ECCO

Fecal microbial transplantation (FMT) is an exciting and evolving methodology to transform the microbiota in microbiota-related diseases. The rationale behind FMT is "transfer of a healthy microbiota" from a donor to a patient with IBD, leading to a change in recipient microbiota towards that of a healthy donor. However, current methods are simplistic. Random healthy donors do not necessarily have an appropriate microbiota, and transferred microbiota may not colonise the recipient’s gut. Diet can rapidly degrade certain taxa or increase others, such that if the recipient diet is not appropriate, donor microbiota expansion may not occur or functionality may be impaired.

Salome de Pinho © ECCO

Aims of the research

The current therapeutic strategies for Inflammatory Bowel Disease (IBD) are limited by effectiveness and/or toxicity, and the selection of patients for therapy remains a major challenge. These clinical concerns highlight the unmet need to identify key mechanisms (molecular markers) capable of being selectively targeted with new and optimised therapies. Glycosylation is a major post-translational mechanism characterised by the addition of carbohydrate structures (glycans) to essentially all cells [1]. Evidence in other immune-mediated disorders has shown that protein N-glycosylation, particularly branched N-glycans, regulates T cell immune response and controls the threshold of T cell activation [2].

Bram Verstockt © ECCO

Aims of the research

The introduction of new non-anti-TNF agents such as the anti-adhesion and anti-IL-12/IL-23 molecules will increase the therapeutic armamentarium for patients with IBD. It is nevertheless anticipated that clinical response and adverse events will vary significantly between individuals. Therefore, we need predictors of efficacy and safety so that we can select the right drug at the right time for the right patient. Targeted strategies in patients with poor prognostic factors and head-to-head trials are currently lacking.

The PANTS study

Nicholas Kennedy © ECCO

Use of the anti-TNF alpha monoclonal antibodies infliximab and adalimumab has transformed the management of patients with refractory Crohn’s Disease. However, clinicians and patients are all too aware that anti-TNF treatment failure is common: 10%–40% of patients fail to respond to induction therapy (referred to as primary non-response: PNR), up to 40% of patients suffer secondary loss of response in the first year of therapy and approximately 10% suffer an adverse drug reaction that curtails treatment.