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Probing the bowels of disease
TORONTO—For decades, patients who suffer from inflammatory bowel diseases (IBD) have mostly had therapies that address only specific symptoms of their condition, but a new industry-academia collaboration in Canada is on a mission to change that with research aimed at identifying the underlying disease mechanisms of IBD.
As patients and the medical community marked World IBD Day on May 19, the Crohn's and Colitis Foundation of Canada (CCFC) and Vertex Pharmaceuticals Inc. announced that they will jointly provide funding for three Canadian academic centers to further research into the biology of IBD, specifically its major types, Crohn's disease and ulcerative colitis. The collaboration is a unique in that it brings together a national healthcare charity and a biotechnology company in Canada, which has a high incidence and prevalence rate of IBD.
"The burden of IBD is enormous in Canada. Over 200,000 Canadians are affected by IBD, and the burden to our healthcare system is great," says Aida Fernandez, chief science and education officer at the CCFC.
In fact, in 2008, the CCFC released its report, "The Burden of Inflammatory Bowel Disease in Canada," which found that IBD was almost as prevalent in Canada as epilepsy or diabetes. In 2008, costs covered by Canada's healthcare system—expenses like hospitalization, surgery, medications and physician visits—were estimated at $753 million. Other significant expenses are not covered by the healthcare system—items like emergency visits, lab work and consultations with nurse practitioners, dieticians and social workers—and it's estimated that IBD incurs more than $1 billion every year in indirect costs like short- and long-term work absences, productivity losses and caregiver work absences.
For Canadians and patients worldwide who suffer from IBD, treatments are usually limited to the use of anti-inflammatory steroids to control disease flares as well as surgery such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy.
"Whatever we can do in terms of improving treatment options and quality of life for patients is very important. That's why we're funding this important, vital research," says Fernandez.
Founded in 1974 by a group of parents whose children were diagnosed with IBD who were concerned about the lack of funding for IBD research, the CCFC is now considered a world leader in IBD research funding, but the organization also focuses on raising awareness of IBD as a chronic disease and addressing issues related to patient access to expensive IBD medications. Of particular concern to CCFC is advancing the understanding of the biology of IBD in the hope that life-altering treatments can be found.
"Ultimately, we want to have something come out of these research projects that will improve our understanding of the mechanisms behind IBD, something that is translatable and can lead to a drug target, that takes us to the next level of something that can be commercialized," says Fernandez. "Sowing early seeds in this endeavor are important, and this is a strong investment in getting the right expertise."
To make this happen, the CCFC has chosen to partner with Vertex, which is headquartered in Cambridge, Mass., but also has facilities in Laval, Quebec, as well as in the U.K. and San Diego. The company has more than 45 scientists focused on IBD research. Vertex also has preclinical and clinical programs for cancer, multiple sclerosis, hepatitis C, cystic fibrosis, epilepsy, Huntington's disease, tuberculosis and influenza.
"Our interest in IBD is to do something that is transformative—to work at the core of the disease, and not just treat the symptoms," says Dr. Louise Proulx, vice president and site head of Vertex Canada. "We really believe this is going to take a network approach. We can 't do everything in-house, and that's why we have chosen to work and collaborate with academic institutions."
The academic research centers in this collaboration were selected after a rigorous peer-review process. CCFC and Vertex then chose three laboratories that are focused on probing the underlying biology of IBD: Dr. François Boudreau of the Université de Sherbrooke; Dr. Brian Coombes of McMaster University; and Dr. Scott Gray-Owen of the University of Toronto.
"There are over 100 genes linked to IBD," notes Fernandez. "The fact that we know this is leading to a more comprehensive understanding of this complex disease. There is now a real momentum in personalized medicine and an investment of research in this area. Knowing which genes people carry will help us to customize treatments for them."
The projects will investigate the role of bacteria in IBD and the body's response to an imbalance of these bacteria in order to identify potential targets for future IBD therapies.
"One of the things we hope to learn more about is how this bacteria enters the body. Can we prevent entry by using a small-molecule, for example? In two years, we hope to have a better understanding of the disease, which will give us new approaches to finding compounds," says Proulx.
The labs will each receive $200,000 in two rounds of grant funding over the course of the two-year collaboration.
"We hope to do another round of applications this summer, and then fund up to another three new institutions," adds Proulx.
"Being able to work closely with other world-class scientists at Vertex and CCFC represents a promising new model for medical research," said Scott Gray-Owen, who is a professor of molecular genetics at the University of Toronto. "We're excited to have been chosen for this grant because it provides an opportunity to advance our understanding of a disease that affects so many Canadians."
The burden of IBD in Canada
Afflicting nearly 201,000 persons in Canada in 2008, inflammatory bowel disease (IBD) is more common than multiple sclerosis or HIV, about as common as epilepsy or type 1 diabetes and somewhat less common than rheumatoid arthritis or schizophrenia.
The total cost of IBD in Canada in 2008 was at least $1.8 billion. This is composed of direct medical costs ($753 million, or 41 percent of total costs) plus indirect societal costs ($1.06 million, or 59 percent of total costs). The average per-person cost is just over $9,000 per year.
Total costs are higher for Crohn's disease (CD) due to greater patient numbers. Per-person costs are also higher for CD, due to more frequent hospitalizations and more costly medications: $9,950 per person per year for CD and $7,900 for ulcerative colitis.
From "The Burden of Inflammatory Bowel Disease (IBD) in Canada," Crohn's and Colitis Foundation of Canada, 2008