Could Mucosal TNF Transcript as a Biomarker Candidate Help Optimize Anti-TNF Biological Therapy in Patients With Ulcerative Colitis?

Abstract

Anti-tumor necrosis factor (TNF) biological therapy has generally been accepted as a standard therapeutic option in inflammatory bowel disease (IBD) patient who are refractory to steroids or immunomodulators. However, the primary and secondary nonresponse rates to anti-TNF bioagents in patients with IBD are high. To improve the response rate, anti-TNF bioagents must be offered to the appropriate IBD patients, and the withdrawal of anti-TNF bioagents needs to be done at the right time. In this context, reliable and reproducible biomarkers can provide important supportive information for clinicians to make correct decisions based on the patient’s individual situation. In this review, we summarized the current understanding of using mucosal TNF transcript (TNF) to improve the precision of anti-TNF biological therapy strategies in patients with ulcerative colitis (UC). Analysis of published literature showed that mucosal TNF could affect the precision of the early identification of candidates who will benefit from anti-TNF therapy prior to treatment, the assessment of response and mucosal healing, and the prediction of discontinuation of anti-TNF biological therapy and relapse after drug withdrawal. Challenges and limitations of using mucosal TNF as a biomarker in applying individualized anti-TNF biological therapy in patients with UC still remain and need to be further investigated.

Inflammatory Bowel Disease Treatments and Predictive Biomarkers of Therapeutic Response

“…Mucosal transcriptomics markers: Biologics therapies can significantly modulate the expression level of mucosal cytokines and suppress the inflammation; therefore, a change in the transcript level cytokines can be used as predictive therapeutic biomarkers of their efficacy. For example, multiple studies have shown reduced mucosal TNF-α transcript levels in response to IFN therapy patients, which correlated well with disease remission and mucosal healing in both UC and CD patients [185,186]. Similarly, blood or mucosal transcript levels of several markers, such as IL-17A, IL-6, IL-7R and interferon (IFN)-γ have been explored as predictive therapeutic efficacy biomarkers of anti-TNF or anti-α4β7 therapies in CD and UC patients (Table 4) [187].…”

Cytokine Signatures in Inflamed Mucosa of IBD Patients: State-of-the-Art

“…Thus, a change in cytokine transcript level can be used as a predictive therapeutic biomarker. There is a plethora of studies that have shown diminished mucosal TNF-α transcript levels in response to anti-TNF therapy, which have correlated positively with disease remission and mucosal healing in IBD patients [75,76].…”