An Integrated Approach to Fighting Inflammatory Bowel Disease

Dr Claudio Fiocchi AN INTEGRATED APPROACH TO FIGHTING INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease (IBD) causes significant pain and discomfort to sufferers and severely affects quality of life. Research on IBD focusing on the individual contributing factors has failed to provide truly effective treatment options, and the broader picture has been somewhat neglected. Dr Claudio Fiocchi of the Lerner College of Medicine, Cleveland Clinic, USA, proposes an integrated, holistic approach which holds significant promise for improving both our understanding and treatment of IBD.

The Challenge of Treating IBD and pinning down the specific causes all the more difficult. Inflammatory Bowel Disease (IBD) involves chronic inflammation of a Dr Claudio Fiocchi, Professor of patient’s digestive tract. Ulcerative Molecular Medicine at the Lerner colitis and Crohn’s disease are the two College of Medicine, Cleveland Clinic, most common types of IBD. Symptoms USA, is working towards a better include fatigue, severe diarrhoea, understanding of IBD, and ultimately, abdominal pain, rectal bleeding, improved treatment options. To achieve weight loss and intestinal obstruction. this, Dr Fiocchi firmly believes we have According to the Centers for Disease to embrace the idiom of ‘out with the Control and Prevention, in the United old and in with the new’. States alone, some three million people are reported as having IBD in 2015. The Need for a Holistic Approach to According to the Crohn’s and Colitis IBD Research Foundation of America, as many as 70,000 new cases of IBD are diagnosed Like in the case of other complex in the United States each year. diseases, the causes of IBD are multifaceted and include Despite advances in modern medicine, environmental, genetic, microbial, and treating IBD is clearly proving to be a immune factors. However, as Dr Fiocchi challenge. One of the main reasons points out, none of these factors alone for this is that IBD is characterised is sufficient to trigger IBD. Rather, IBD is by an overwhelmingly complex set likely caused by complex interactions of pathogenic (disease-causing) among them. Unfortunately, much mechanisms. The complexity of the of the research into IBD to date has disease is compounded by the diversity focused on the individual contributing of each sufferer’s symptoms, treatment factors in isolation. As a result, is a major obstacle to enhancing our experiences, and lifestyle choices. These progress has been limited. Dr Fiocchi understanding of IBD and identifying factors make researching the disease argues that this blinkered approach a cure.

WWW.SCIENTIA.GLOBAL ‘My current conviction is that the scientific and medical IBD community must accept new ways to look at IBD and realise that definitive answers, correct diagnosis and truly effective therapy can only be achieved if we adopt and integrate new methodologies that can evaluate the disease as a whole’.

‘The IBD Interactome’, credit Claudio Fiocchi

If progress is to be made in treating IBD, To understand this definition, we level. Such an in-depth approach, then something needs to change. need to understand what is meant however, requires methodological Dr Fiocchi explains, ‘my current by omes. The term originates from innovations to existing procedures conviction is that the scientific and terminology that conveys a sense of and introduces a whole new set medical IBD community must accept the totality of any particular complex of challenges. new ways to look at IBD’. He continues, system, wholeness, or completion. For ‘we must realise that definitive answers, example, contributing factors related Methodologies for Studying the IBD correct diagnosis and truly effective to the environment are referred to Interactome: Systems Biology therapy can only be achieved if we as the patient’s exposome. Genetic, adopt and integrate new methodologies microbial, and immune contributing According to the National Institutes of that can evaluate the disease as a factors are referred to as the patient’s Health, systems biology is an approach whole’. With this premise in mind, Dr genome, microbiome, and immunome, to biomedical research that aims to Fiocchi conceptualised the so-called respectively. These are among those understand the larger picture – be it ‘IBD interactome’. most often researched but there are, at the level of the organism, tissue, or of course, other potential contributing cell. Systems biology is the opposite The IBD Interactome factors, or other omes. of reductionist biology, which, in contrast, involves taking the pieces Dr Fiocchi wanted to develop a new The overarching purpose of the IBD apart to further our understanding. In approach to IBD research where interactome concept is to move light of the theoretical premise of the all relevant information would be away from studying single omes that IBD interactome, a systems biology integrated into a comprehensive contribute to IBD in mere isolation. approach is ideal for studying IBD. picture of the disease. In line with the By adopting a holistic, integrative However, it also introduces further terminology often used, he termed approach, Dr Fiocchi hopes to gain methodological complexity. this integrated approach the IBD deeper, more detailed insights into interactome. The interactome, as the disease-causing mechanisms. By For example, a systems biology it pertains to IBD, is a biological facilitating an unbiased investigational approach to researching IBD requires network, in which Dr Fiocchi approach, the IBD interactome one to collect a large range of bio- proposes that dysregulated interaction is capable of detecting relevant samples including blood, serum, between ‘omes’ causes chronic pathogenic interactions at a molecular endoscopic biopsy samples, and stool. intestinal inflammation.

WWW.SCIENTIA.GLOBAL Researchers working in different fields of expertise need to this complex and varied data. As well as simultaneously analyse these samples for a whole range of different aspects. bringing together all the relevant data, this approach will also They then need to collect and integrate the data accumulated allow researchers to study the disease at a more detailed, from these tests and deduce it into something biologically molecular level. Dr Fiocchi believes that future research using meaningful. It becomes immediately apparent that application a bioinformatics systems biology approach will be critical of this approach in IBD would entail an enormous amount of in identifying the key molecular components in IBD. In this work, as well as some serious information processing power. way, we will be able to understand how these molecular The good news is that there is a way in which this may feasibly components regulate their networks, as well as how these be achieved – and it lies in the science of bioinformatics. various networks interact with one other. This work will contribute to a much better understanding of the mechanisms Bioinformatics and Computational Biologists to the Rescue underlying IBD.

Bioinformatics refers to the use of statistical modelling and Moving Away from the ‘Parallel Separate Approach’ algorithmic processing to understand complex biological data. In the case of IBD research, Dr Fiocchi proposes that a In conclusion, the work of Dr Fiocchi represents a significant large body of data from analyses covering vast research areas departure from the ‘parallel separate approach’ to IBD research. would be fed into an appropriate bioinformatics tool. These In this approach, the potential causes of disease have been tools would then help to construct meaning from the results. treated as isolated entities by researchers operating in their However, this would not be a mindless process in which a own field of expertise in their study of a sole contributing factor. computer spits out some sort of magic number. Rather, the use Although knowledge and expertise grow in these fields of of bioinformatics in the study of IBD needs to be supported research, they continue to run parallel to one another and the by computational biologists who are knowledgeable about potential connections between them remain elusive. the disease processes. With this expertise on hand, data from an extremely large body of analyses can be translated into Dr Fiocchi has pioneered a new approach to the study of IBD by something meaningful to IBD researchers. conceptualising the IBD interactome in which all the potential causes of IBD and associated fields of research are brought However, it is important to remember that bioinformatics, at together into one entity. This integrated and convergent present, is not a ‘silver bullet’ for IBD research. There are still approach will ensure that as knowledge increases, the limitations to just how much data can be processed. Although connections between fields become apparent, thus addressing there are a number of omes of interest, we do not currently the inherent complexity of IBD diseases. Future research into have bioinformatics tools and algorithms capable of integrating the IBD interactome will be facilitated by a systems biology all the analyses required. Thus, work to date focuses on only methodology and powerful bioinformatics tools that will the most significant omes known to contribute to IBD. analyse and construct meaning from the large bodies of data. This holistic and integrated approach to studying IBD holds In summary, evaluating the large amount of information considerable promise for the development of much-needed compiled using a systems biology approach to IBD research treatments for IBD. requires state‑of‑the-art bioinformatics tools to synthesise

WWW.SCIENTIA.GLOBAL Meet the researcher Dr Claudio Fiocchi Department of Inflammation & Immunity Lerner Research Institute, Cleveland Clinic Cleveland, Ohio USA

Dr Claudio Fiocchi received his M.D. from the Santa Casa de KEY COLLABORATORS Misericordia de São Paulo School of Medicine, São Paulo, Brazil in 1969. Between 1970 and 1980, Dr Fiocchi undertook Dr Dimitrios Iliopoulos, Kynan Pharma, Los Angeles, USA further training in internal medicine, immunology, and Dr Heitor S.P. de Souza, Federal University of Rio de Janeiro, Rio gastroenterology and has since held several staff positions de Janeiro, Brazil and prestigious professorships at the Cleveland Clinic and Case Western Reserve University, USA. Having published FUNDING prolifically on inflammatory bowel disease, Dr Fiocchi has been an invited speaker at many international conferences National Institute of Diabetes and Digestive and Kidney and served on a number of grant and journal review boards. As Diseases (National Institutes of Health) a result of Dr Fiocchi’s longstanding commitment to research European Crohn’s & Colitis Organization and education in the field of inflammatory bowel diseases, he has received numerous accolades, including the MERIT FURTHER READING Award, National Institutes of Health, USA (1999), the Honorary Foreign Membership, Brazilian National Academy of Medicine HSP de Souza, C Fiocchi, Network medicine: A mandatory next (2010), the Henry Janowitz Lifetime Achievement Award step for inflammatory bowel disease, Journal of Inflammatory from the Crohn’s & Colitis Foundation of America (2010), the Bowel Diseases, 2018, 24, 671–679. International Herbert Falk Award, Falk Foundation, Germany C Fiocchi, Inflammatory bowel disease: Complexity and (2013), and most recently, the Research Mentor Award from the variability need integration, Frontiers in Medicine, 2018, 5, 75. American Gastroenterological Association (2018). HSP de Souza, C Fiocchi, D Iliopoulos, The IBD interactome: An CONTACT integrated view of aetiology, pathogenesis and therapy, Nature Reviews: Gastroenterology and Hepatology, 2017, 14, 739–749. E: [email protected] W: https://www.lerner.ccf.org/pathobio/fiocchi/