Biological and cellular therapy of inflammatory bowel diseases

Relevance: 

Inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn's disease (CD), represent one of the most serious and unresolved problems in modern gastroenterology. In terms of the incidence of B3K, they are significantly inferior to other diseases of the digestive system, but in terms of the severity of the course, the frequency of complications and mortality, they occupy one of the leading positions in the structure of diseases of the gastrointestinal tract worldwide. In recent decades, there has been an increase in the incidence and prevalence of Crohn's disease (CD) and ulcerative colitis (UC), the two main forms of inflammatory bowel disease (IBD). The United States and European countries have higher rates than other countries in the world. Both forms of IBD increase the risk of developing colon cancer, and both pathologies significantly increase the overall morbidity and mortality in the world. Debuting at an early age, they remain active for a long time, and eventually lead to disability. The etiology of UC and CD is still unknown, and the pathogenesis of IBD is caused by complex interactions of genetic, microbial, immune, and environmental factors. Only a comprehensive approach to the study of the pathogenesis of this pathology from the positions of various disciplines, such as molecular microbiology, immunophysiology and neuroimmunology, can make it possible to find new methods of IBD therapy. Despite the absence of an etiotropic treatment for IBD, the rapid development of high medical and pharmaceutical technologies contributes to the creation of an increasing number of new drugs for the treatment of IBD, which will certainly increase the effectiveness of the treatment of these diseases. The use of biological agents in clinical practice already allows us to help many patients who are refractory to all other known methods of therapy. The recognition of the important role of TNF-a in the pathogenesis of immuno-inflammatory diseases led to the development of monoclonal antibodies aimed at inhibiting this cytokine. Biological therapy (BT) has largely changed the basic strategy of IBD therapy, and the perception of its possibilities. With the help of BT, it was possible to achieve significant improvement and even complete elimination of the disease activity in patients who were resistant to all previous treatment methods, including glucocorticosteroids and immunosuppressants. For the first time, it became possible to consider the real goal of treating CD and UC to achieve remission of the disease. The first BT drugs were tumor necrosis factor–a (TNF-α) inhibitors. However, about a third of patients are forced to stop treatment due to the development of secondary inefficiency or side effects. Given these circumstances, at present, the attention of clinicians has attractedcell therapy, as one of the methods of correction of local and systemic immunity, as well as a way to enhance the regeneration of damaged tissues.

As part of the program, we:  

1. We will discuss the epidemiological and pathogenetic mechanisms of inflammatory bowel diseases, the frequency and types of extra-intestinal manifestations of IBD, and the current classification of ulcerative colitis and Crohn's disease.
2. We will study the criteria for the differential diagnosis of IBD: biochemical, microbiological markers, histological features, endoscopic features of damage to the intestinal mucosa in inflammatory bowel diseases and other intestinal pathologies.
3. We will study the main indications for the appointment of genetically engineered biological drugs, taking into account the comorbidity of IBD, the mechanism of their action, the profile of their safety and monitoring of their effectiveness.
4. We will study the indications, methods of switching and optimizing the therapy of GIBP within one class of drugs, the algorithm for switching to GIBP with a different mechanism of action.
5. We will study the place of cell therapy in the modern complex anti-inflammatory therapy of inflammatory bowel diseases.
    

Base: department of Treatment of inflammatory bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM. 
Internship Supervisors: Parfenov A. I., MD, Professor, Head of the Department of Intestinal Pathology, State Medical University MCSC named after A. S. Loginov DZM.
Knyazev O. V., MD, Head of the Department of Treatment of inflammatory bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Ruchkina I. N., MD, Senior researcher of the Department of Intestinal Pathology of the State Medical Institution MCSC named after A. S. Loginov DZM.
Kagramanova A.V., PhD, Senior researcher of the Department of Treatment of Inflammatory Bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.
Lischinskaya A. A., PhD, Senior researcher of the Department of Treatment of Inflammatory Bowel Diseases of the State Medical Institution of the MCSC named after A. S. Loginov DZM.