Predictive Analytics, Risk Factors May Help Identify Crohn’s Disease

March 31, 2020 - Mount Sinai researchers have developed new predictive analytics tools and identified environmental risk factors that could lead to a new understanding of what triggers Crohn’s disease.

In a series of four studies published in the journal Gastroenterology, Mount Sinai inflammatory bowel disease (IBD) researchers offer new ways to identify individuals who have a high likelihood of developing the disease. This could result in more effective prevention efforts, the team stated.

“Early identification of individuals at high risk for disease development could allow for close monitoring and interventions to delay, attenuate, or even halt disease initiation,” said Jean-Frederic Colombel, MD, Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai and Co-Director of Mount Sinai’s Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center.

“This is highly relevant as we seek to predict and prevent IBD, which continues to sharply increase in numbers across the globe. In the absence of a cure, our clinical strategy will center on aggressive and innovative mechanisms to predict and prevent the disease.”

In one study, researchers examined the impact of deep remission in patients recently diagnosed with Crohn’s disease. The team collected and analyzed long-term follow-up data among 122 Crohn’s patients who participated in The Effect of Tight Control Management on CD (CALM) study, a large, 31-site study that evaluated the effect of tight control of early Crohn’s.

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The results showed that achieving deep remission early on was associated with an 81 percent decrease in risk of adverse outcomes over a median of three years.

“The data suggests strongly that achieving deep remission early in the course of Crohn’s disease can lead to disease modification with a significant decrease in long-term complications,” said lead author Ryan Ungaro, MD, MS, Assistant Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai and a member of  Mount Sinai’s Feinstein IBD Clinical Center.

“The implication is that we can play a big role in slowing the disease progression if we catch and treat Crohn’s early, highlighting the relevance of prediction and prevention in treating Crohn’s.”

In a second study, the team examined serum biomarkers of military personnel collected and stored by the US Department of Defense and built a predictive analytics model for Crohn’s disease. Researchers were able to identify 51 protein biomarkers that could predict the onset of Crohn’s disease five years before diagnosis, with an accuracy of 76 percent.

“The study suggests that biological processes are activated many years before Crohn’s, opening the possibility of developing targeted strategies that could work to prevent or delay disease onset,” said lead author, Joana Torres, PhD, MD, Adjunct Assistant Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai.

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“Although we recognize that a preventive strategy may still be many years down the road, studies analyzing samples taken years before diagnosis will likely contribute to a greater knowledge of disease pathogenesis and have the potential to help us improve treatments. When we combine this finding with the knowledge that early intervention can lead to better outcomes for our Crohn’s patients, we have a truly relevant headline for a disease that has no cure.”

Researchers also conducted a study of metal exposure in the baby teeth of patients who went on to develop IBD later in life. Together with colleagues in Portugal, Mount Sinai researchers collected data from 28 adult Portuguese patients. The team was able to retrieve the baby teeth of 12 IBD patients and 16 unaffected controls, studying the association between early-life metal exposures and future risk of IBD.

“The data suggests that metal exposure during a critical window in early life may be a risk factor for IBD,” said Manish Arora, PhD, Professor of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai. 

Finally, researchers studied IBD within Ashkenazi Jewish families, a population that has an approximately four-fold increased prevalence of IBD. The team examined 38 large families with three or more first-degree family members with IBD. Their findings showed that affected siblings were significantly more likely to be sequentially affected, with siblings with IBD clustering together within families.

“The clustering of affected siblings suggests there are factors beyond genetics that lead to the development of IBD in these multiplex families, likely attributable to a shared environment,” said lead author Elizabeth Spencer, MD, Pediatric Advanced IBD Fellow at the Icahn School of Medicine at Mount Sinai.

“We are continuing to follow these families in an effort to pinpoint the precise factors. If we can identify these factors, we could alter them as a preventative measure for those at high risk of developing IBD.”

The results of these studies offer more insights into IBD and Crohn’s environmental risk factors, which could lead to more targeted care and stronger prevention efforts.

“As we approach nearly one hundred years since the discovery of Crohn’s by Burrill Crohn at Mount Sinai Hospital in 1932, we see ourselves in a new era where our core scientific innovation will focus on prevention, as a cure continues to elude us. Therefore, our research focus and our team of researchers are aligned as the ‘Road to Prevention Group,’” said Colombel.