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Gene Network

Opinion: Dr. Claudio Fiocchi “The need for AI-based precision therapy in inflammatory bowel disease”

Claudio Fiocchi

The evolution of therapy for ulcerative colitis (UC) and Crohn’s disease (CD), the two main forms of inflammatory bowel disease (IBD), is a prolonged succession of vastly different approaches. After initial evidence of effectiveness of salazopyrine in UC patients in the 1940’s, many other medications were progressively introduced, including corticosteroids, aminosalycilates, immunosuppressors, antibiotics, and so on. While variable beneficial results were observed, they were not permanent and were accompanied by adverse side effects. With the advent of biologics in the mid-1900’s whole new and more effective medications became available, but they also displayed temporally limited benefits and side effects. This is also true for the most recently introduced medications such as anti-integrin antibodies and blockers of signaling molecules or leukocyte migration. Furthermore, even though some are molecularly selective, all current drugs basically mediate generic anti-inflammatory effects.

One of the key reasons for failing to develop truly efficacious approaches for IBD is its overwhelming biological complexity, where the combination of multiple factors (omes) triggers and maintains a chronic state of inflammation in the gut. Such biological complexity cannot be solved by studying each ome in isolation, as it has been traditionally done, and drastic new approaches are needed that go beyond what has been done so far. IBD information has evolved into “big data”, whose amount and intricacy are no longer manageable by the human mind, and require the vastly greater storing and processing capacity of artificial intelligence (AI). AI has the additional advantage of being “unbiased”, unlike doctors that make therapeutic decisions based on individual knowledge and personal experience, both of which vary among medical professionals.

We clearly need to open a brand-new approach to medicine, i.e., “network medicine”, which embraces multiple influences and uses AI to integrate biological networks (interactomes) to identify the molecular drivers (hubs) of complex diseases like IBD. This novel approach not only will reveal new insights into the mechanisms of IBD but, more importantly, will lead to the implementation of precision therapy for UC and CD patients.