Towards a 'cure' for IBD.
To discuss a cure for IBD, one should first define the concept 'a cure'. If it is intended as the general restoration of health, this is already possible, as many current therapies do a good job in inducing long periods of remission in Crohn's disease, and colectomy can technically cure ulcerative colitis. If it is more strictly defined as the complete and permanent elimination of the cause, predisposing and permissive factors, reinstatement of normal microbial ecology and restoration of mucosal immune homeostasis, then a cure for IBD is out of reach, at least for now. Regardless of the definition, major strides have been made in attempting to cure IBD by addressing the key components of its pathogenesis: the environment (exposome), the genetic makeup (genome), the gut microbiota (microbiome) and the immune system (immunome). However, the isolated modulation of each component is insufficient to provide a cure, and different requirements may be needed depending on the stage of the disease and each patient subset. To achieve a cure, one key approach is currently missing: the integration of knowledge from all the pathogenic components. We continue to learn more and more about each component using traditional 'canonical' systems, which allow the accumulation of data without taking into consideration the other components. We are still not studying the 'omes' of IBD, we should be using 'omics' technologies that can generate a more global vision of IBD pathogenesis on which to base novel, multiple pathway-integrated therapies.
Department of Gastroenterology and Hepatology, Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. fiocchc@ccf.org
Claudio
C
Fiocchi
D018450:Disease Progression; D004777:Environment; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007107:Immune System / Q000276:immunology; D015212:Inflammatory Bowel Diseases / Q000235:genetics / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D054892:Metagenome