Y-ECCO Interview Corner: Bram Verstockt

Growing up in Belgium – Was IBD something you always wanted to work in or did you come to it later? How did you come to medicine and IBD specifically?

I would say that it all came very spontaneously. Although I did not grow up in a “doctors’ family”, I was convinced from a very early age that I should study medicine because I wanted to interact with people and help them. In addition, I was very interested in health and the human body and that, combined with the social aspect, quickly stimulated my interest and passion for starting medical school.

During the last months of my internship at medical school, I had a rotation of three weeks at the IBD infusion unit, where I had the luck of getting in touch with Professor Paul Rutgeerts. It was on that ward, back in 2013, where I encountered for the very first time patients with Inflammatory Bowel Disease and experienced the impact IBD can have on people. These literally were my first steps into IBD.

A couple of months later, during my first year as registrar, I attended a lecture by Professor Séverine Vermeire about the basic principles of IBD and the era of advanced therapies; back then there was only anti-TNF, and anti-integrin was just around the corner. Remembering my time at the infusion unit a couple of months earlier, I was so inspired by her lecture that afterwards I approached her, and asked whether I could start a PhD in IBD. I had already known for quite a while that I wanted to combine clinical work with (translational) research, and at that moment all pieces of the puzzle fell together. From then onwards it all went very fast: she introduced me to the IBD Leuven team, we brainstormed together with Professor Marc Ferrante – my future promoter – on a potential PhD project, and in 2015 I interrupted my residency and started a 4-year full-time PhD programme. And I would say that all the rest is now history: after defending my PhD in 2019, I completed my residency in 2021. My mentors became my colleagues, and I am very fortunate currently to be able to work in the unit with Séverine, Marc, João and a fantastic team of paramedics, colorectal surgeons, radiologists and pathologists, as well as an amazing team in our lab.

You have worked in several places, including Malta. How did you find moving around improved and impacted your training? Would you recommend it?!

It all started again during my final year of medical school, where I applied for a rotation of a few weeks abroad: I was placed in Malta for my six-week rotation in Obstetrics & Gynaecology, so the Mater Dei Hospital in Malta was my first working experience abroad.

For all younger colleagues, I would highly recommend performing one or more internships or research stays abroad. It provides you with a different view on different healthcare systems, and also scientifically it challenges you to think differently about research questions compared to the environment in which you were trained.

So when I started my PhD, Séverine and Marc suggested that I move abroad for the first year of my PhD. I’m still very grateful for that opportunity, and I was very lucky to move to Cambridge (UK), together with my wife, and spend my entire first PhD year there in the lab of Professor Kenneth Smith, in close collaboration with James Lee, who was my supervisor, although remotely given his research stay in Boston. Nuru Noor, one of our current Y-ECCO Committee Members, was actually one of my very first lab mates in Cambridge. We spent hours and hours isolating PBMCs, sorting cells, extracting RNA, writing and running codes. It was also during that research stay that I got to know Professor Arthur Kaser and Tim Raine, who truly became a friend afterwards. I still have fantastic memories about that year, both scientifically and privately. I would say that moving around always opens your eyes. It's good to have and learn different perspectives, you always take a lot back home both clinically and scientifically, and it clearly sharpens your mind and critical thinking.

Finally, by the time I graduated from my residency in GI and was about to start as a consultant in Leuven, I was intrigued about intestinal ultrasound, which is unfortunately not yet part of the formal GI training in Belgium. So, I moved for a third time, this time without my wife and my two children, who had been born by that time, and spent another month abroad in Lüneburg (Germany) with Professor Christian Maaser, Professor Torsten Kucharzik and Dr. Frauke Petersen. There I had the enormous pleasure of being trained and extensively exposed to the beauty of intestinal ultrasound.

To me, moving abroad as part of your training is one of the best things you can do as a young physician and/or young researcher. It definitely brings so much value, not just purely on paper for your CV, but also in the way you think, the way you approach problems. It also helps to expand your network, which will for sure be very relevant for the rest of your career.

For someone so young, you have worked in personalised medicine for a long time – Why do you think predictive biomarkers have proven so difficult?

As you indeed pointed out, throughout my PhD and also subsequently, personalised medicine has always been extremely close to my heart. Unfortunately, I would say as a field, we have not yet been able to crack the code. One of the key aspects to me is that IBD is such a very heterogeneous condition, which complicates things a lot. And the heterogeneity is present not only among patient phenotypes but equally in IBD pathogenesis: it's such a complex interplay between genetics, immune system, microbiome and so many environmental factors we still don't know. And that's to me presumably the most challenging aspect of personalised medicine: we just are not able to capture that heterogeneity in the way we should.

We have come a long way, and many have proposed promising markers; there may even be a robust translational and strong basic science background to support the hypothesis for a given marker. But until now, I think, not a single one is truly standing, apart from maybe the TPMT and NUDT15 genotypes linked to myelotoxicity of thiopurines and the HLA haplotype reported by the Exeter Group and the PANTS team on immunogenicity to anti-TNFs.

Others have clearly shown a lot of promise, including, for instance Oncostatin-M, Trem-1 and the beautiful CD8 T-cell exhaustion signature from the Cambridge group, but unfortunately so far none of those has really made it into daily clinical practice for the reasons I just mentioned. We simply cannot validate and replicate these findings in independent cohorts. I think we still have a long way to go, and presumably we should approach precision medicine in a different way, and try to capture as much as possible the heterogeneity we were discussing. Multi-omics are part of that answer, at least to a certain degree.

You are an IUS specialist – Is colonoscopy dead? How do you see bowel ultrasound impacting patient care?

You’re right, apart from personalised medicine, intestinal ultrasound is also a topic very close to my heart. That being said, it does not necessarily mean that colonoscopy is fully dead. There will always be a place for colonoscopy: at this stage we still need tissue to diagnose patients and we still need colonoscopy to surveil a colon, because ultrasound cannot capture polyps or dysplastic lesions, for instance. So to me, colonoscopy is there to stay, at least to some degree.

The beauty of intestinal ultrasound is that it's just an extension of your clinical examination. When I'm seeing patients in my practice, I scan them and this immediately gives me an idea about how their disease is being controlled. In addition, it allows me to actively engage the patient in the monitoring process or demonstrate to them that something is not entirely okay. Bowel ultrasound has many more advantages, but the biggest one really is the point-of-care concept, immediately allowing you to take decisions, which can speed up the process significantly because we want to act quickly and in a timely way, especially in this treat-to-target era. It takes some energy and investment to be fully trained, but you and your patients will love it once it’s part of your unit. You just need a single positive case where it immediately changes the management of an individual patient, and your entire team will be convinced. And that’s what it’s all about: accurate information which is readily available, ideally non-invasive and with a favourable impact on your patient’s journey!

What advice would you give to yourself 10 years ago?

That’s a difficult one. What advice would I give to myself 10 years ago? Well, first of all, to make things very clear, I don't regret anything – or almost anything – about my journey over the past nine years since I took my first steps in the IBD field as a first year PhD student. So I would definitely tell myself, and everyone else at that stage of their career, “enjoy every second”. If you're passionate about something, if you love what you're doing, you’re on the right track, and this is the key thing in life.

And when you love doing research, when you love to educate, when you love to care about patients, and this is really what makes you happy, you should just go for it and don't give up. And of course, I think in every journey – be it a clinical journey or a research project – not everything is always plain sailing and in line with what you originally envisioned. But even then, try to stay focused and passionate about what you really want to achieve: things ultimately will be fine.

For me really one of the key things apart from scientific success – no matter how one would define or assess that –, and way more important than whatever publication or grant you achieve, is really the joy you have and the pleasure you experience in what you are doing. This is what matters most at the end of the day. For me personally, in these past nine years, this has been being part of a community, a family. The IBD Community to me has always felt very friendly and warm, nationally and internationally, and I’m very fortunate to be welcomed in Leuven by a very warm, collaborative and enthusiastic team.

Being part of this large ECCO Family, in particular, has given me a lot. I've participated in many ECCO Projects and I've been very grateful to be actively involved within Young ECCO over these past years. However, ECCO has given me a lot more than just being part of these projects and committees. It has given me colleagues and friends with whom I can speak about things way beyond our professional journeys, including our private journeys, which ultimately are even more important in life. So, I would definitely recommend that everyone at a very early stage in their career interacts, engages and enjoys the welcoming atmosphere of the IBD Community, including inspiring and motivating mentors!

And maybe a final piece of good advice I would give to myself 10 years ago – and to others at the same or earlier stages of their career – ‘learn to say no’. This is something my mentors also had to remind me about, and presumably they sometimes still need to, and they were and are fully right.

Which brings me to the final question. You manage to fit all this in with a young family – What do you do to unwind?

I'm very passionate about what I'm doing, my research, my clinical and educational activities, my participation in societies like ECCO. It really doesn't always feel like work, but obviously it requires a large investment of time and energy. I’m really sitting here as a happy and grateful person, not regretting anything and having the privilege to do what I love most. But I realise that I'm extremely fortunate to have a hugely supportive wife, who supports me in all the professional decisions and commitments I make. It’s obviously not always easy to find an excellent balance between work and life, but so far we are managing quite well.

So, what I really enjoy and what I do to unwind is sharing very precious moments with our family, including our two boys. We love travelling, but also very small things can mean the world to them, and to me: playing a game, cheering for them while they are taking part in sports, reading a book together or playing some music can be very rewarding when you see the joy and the love in their eyes.

Apart from that, I love going to a concert: I have a very broad interest in music, ranging from classical music and opera through to festivals, rock and pop concerts. Having a good night out with family or friends, accompanied by a good glass of wine and some fantastic Belgian food or another cuisine can really help me to relax. On top of this, I try, more than I did before, to get enough exercise, so twice a week you’ll find me in the gym at 6:30 a.m. to ensure I am fully energised prior to going to the hospital: mens sana in corpore sano!

Thank you Bram, you have been a pleasure to work with over the last years in Y-ECCO and we look forward to seeing what you get up to next in ECCO!