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The pathogenesis of Crohn’s disease (CD) is complex and multifactorial, involving genetic predisposition, diet, and the intestinal microbiome. Prior studies have shown increased intestinal permeability prior to the onset of CD, suggesting that such a defect allows translocation of intestinal microbes and the development of anti-microbial antibodies associated with CD. Biological markers, such as fecal calprotectin and CRP, reflect to some degree the level of intestinal inflammation in those with known CD; however, these markers are only used after CD has manifested.
I selected a study as my story of the year because of its potential for paving the way for intervention strategies prior to CD onset that could prevent its development.1 The group of investigators identified a set of six anti-microbial antibodies that were elevated more than 3 years before the diagnosis of CD. These antibodies are elevated prior to the enhanced intestinal permeability previously shown to predate the diagnosis of CD. The identification of easily measurable markers that predict several years in advance which individuals will go on to develop CD provides a strategy for interventions that could mitigate CD development. The data presented in this paper suggest that personalized pre-disease approaches such as manipulation of the intestinal microbiome, diet, or other treatments could be used to prevent the development of CD. Much more work will be required to bring such approaches to reality, but the first step in this process, the identification of pre-clinical biomarkers, is key in that it sets the stage for intervention treatment studies by identifying at-risk individuals. This major step forward stands to provide hope to individuals at risk of developing this life-long disease.