Current and Future Biological Treatments in Inflammatory Bowel Disease

The biologic approach to IBD therapy has developed in recent years as a result of a better understanding of specific immunopathological processes in intestinal inflammation. Advances in the development of biologic drugs were the result of two major findings, in basic research: 1) The ability to dissect immunopathologies in the intestinal mucosa up to the level of single molecules. The best example of such progress is the generation of sophisticated experimental models of inflammatory bowel disease such as knock-out and transgenic mice in which experimental colitis is exacerbated or ameliorated because of the lack or over expression of a single gene. Treatment strategies to decrease/neutralize or increase the concentration or effect of the protein encoded by that gene can be performed. 2) Advances in biotechnology now enable the insertion of genes into viral vectors so that targeted delivery of cytokines is possible, antisense oligonucleotide can be designed to hybridize with target RNA’s thus the expression of specific molecules can be decreased, commercial amounts of growth factors generated and humanized antibodies creating less immunogenicity can be engineered. There are several categories of treatments that are relevant to IBD such as 1) Anti-Tumoral Necrosis Factor alfa (TNF-┙) antibodies; 2) Selective adhesion blockade; 3) Recombinant cytokines; 4) Growth factors; 5) Immunostimulation; 6) Nucleic acid based therapies; 7) Gene therapy; 8) Autologous bone-marrow transplantation; 9) Helminths, 10) Apheresis.