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Challenges of Translation of Anti-Fibrotic Therapies into Clinical Practice in IBD

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Fibrostenotic Inflammatory Bowel Disease

Abstract

Fibrosis is an important clinical problem and affects a high number of patients with inflammatory bowel diseases (IBD). Anti-inflammatory therapies may not be sufficient to prevent intestinal fibrosis in IBD patients. Several anti-fibrotic treatment approaches have been developed. However, there are significant challenges in translating these anti-fibrotic therapies into clinical practice in IBD.

Anti-fibrotic therapy approaches in IBD are complicated by the fact that an effective and intact wound healing response and effective repair mechanisms are essential in Crohn’s disease and ulcerative colitis patients. This implies that the anti-fibrotic therapies must not interfere with repair and tissue regeneration. Strategies interfering with transforming growth factor (TGF)β expression and activation are promising in other fibrotic diseases but may lead to more inflammation in IBD. The specific pathophysiology of IBD makes it difficult to extrapolate clinical data obtained with anti-fibrotic agents in other diseases than the gut. Another challenge is the lack of clear-cut clinical endpoints and readout for clinical trials for intestinal fibrosis. At present, the development of anti-fibrotic therapies takes place in other diseases such as lung and liver fibrosis. It will be important to develop new clinical endpoints for intestinal fibrosis trials to test new anti-fibrotic treatment strategies in IBD to benefit from progress in other fibrotic diseases.

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Abbreviations

CD:

Crohn’s disease

IBD:

Inflammatory bowel disease

IL:

Interleukin

UC:

Ulcerative colitis

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  1. Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland

    Gerhard Rogler

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  1. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Florian Rieder

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Rogler, G. (2018). Challenges of Translation of Anti-Fibrotic Therapies into Clinical Practice in IBD. In: Rieder, F. (eds) Fibrostenotic Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-90578-5_20

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