What problem is the research hoping to solve?

There is currently no cure for Ulcerative Colitis. People living with the condition experience unpredictable periods of relapse, known as ‘flare-ups,’ and remission. Medication can help in lots of cases, but not all. When treatments fail, surgical removal of inflamed bowel sections becomes the only option. All this can have a significant impact on an individual’s quality of life, mental health, and social wellbeing.

Recommended treatments include medicines called ‘biologics’ which aim to establish and maintain symptom-free remission. These medicines work by blocking the proteins, called cytokines, that ‘switch-on’ inflammatory responses. This, in turn, reduces inflammation. Biologics are now the most prescribed therapy for Ulcerative Colitis and there are different types, each targeting a different inflammatory protein. For some people, a particular biologic may help reduce inflammation, but for others it does not.

Recently, our research has shown that bowel inflammation in Ulcerative Colitis varies from person to person. When looked at under a microscope, we see different cells and molecules contributing to disease in different people. Despite these differences in the features of the disease, biologics are prescribed in a ‘one-size-fits-all’ manner. This approach fails to consider the individual molecular characteristics of the patient’s bowel inflammation at the time of treatment.

Typically, a patient first receives infliximab or adalimumab, which blocks a particular protein called tumour necrosis factor, or TNF. If that fails, they move on to other biologics. More than half of people with Ulcerative Colitis do not respond at all to infliximab or adalimumab, or they stop responding after a period of time and their inflammation returns.

Our new project aims to decrease the failure rates of current treatments and should bring us much closer to personalised medicine for Ulcerative Colitis.

So, what will you be doing?

If we can identify which biologics an individual is likely to respond to, we can improve treatment success rates. We’ll study the molecular and microscopic characteristics of an individual’s Ulcerative Colitis inflammation and use it to determine which medicine shows most promise for that person.

We will measure these characteristics in routine diagnostic biopsies (examining the tissues of the bowel) and then test whether the information reported could have predicted the success or failure of current advanced therapies including biologics.

Combined with specialist medical opinion from gastroenterologists, we hope these methods will help improve success rates of biologic therapy. If eventually used in clinical care, this will enhance quality of life for people living with Ulcerative Colitis and avoid unnecessary costs for healthcare systems.

Tell us a bit about the project so far and how patients and the public will be involved?

The project started in October 2021 and Crohn’s & Colitis UK have supported us to involve people living with IBD in the study design to ensure the research meets their needs. At our first patient focus group meeting, we agreed on how to communicate the aim and findings of the study to people living with the conditions, and the broader public.

These patient representatives bring diverse views to the research and are already sharing skills that are valuable to this project. This includes supporting us to communicate about the study to the public, including information about the science, research into biologic medicines, and Artificial Intelligence (AI) software development, which teaches a computer to carry out tasks that are usually done by humans.

Throughout the project, scientific meetings will include people with Ulcerative Colitis so that we take the most direct path to benefitting patients in the clinic. Being involved gives people living with the conditions deeper insights into what day-to-day research means and we hope there will be opportunities for our patient representatives to do one-day placements with hands-on experience in the lab.

Who can take part in this study?

Any patient with Crohn’s or Colitis and their family members or friends are very welcome to get involved. As a group, we continue to explore ways we can involve people in our research design. At present, this includes participating in regular meetings and this ongoing blog series for Crohn’s & Colitis UK.

In future, participants will have the opportunity to visit labs, and work towards new ways of raising awareness of to the wider public and underrepresented groups.

Other upcoming opportunities may include fundraising activities and in-person day events to bring researchers, healthcare professionals and people living with Crohn’s and Colitis together.