Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 25, 2015; 7(7): 670-674
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.670
Gastrointestinal endoscopy biopsy derived proteomic patterns predict indeterminate colitis into ulcerative colitis and Crohn’s colitis
Billy Ray Ballard, Amosy Ephreim M’Koma
Billy Ray Ballard, Department of Pathology, Meharry Medical College School of Medicine, Nashville, TN 37208-3599, United States
Amosy Ephreim M’Koma, Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, Nashville, TN 37208-3599, United States
Amosy Ephreim M’Koma, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN 37208-3599, United States
Amosy Ephreim M’Koma, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37208-3599, United States
Author contributions: Ballard BR contributed in histopathology interpretation of surgical pathology endoscopy biopsy specimens, identification of normal tissue vs pathological areas of interest and material support; M’Koma AE made the contributions to studying the concept and design, analysis and interpretation of data, drafting and critical writing of manuscript for important intellectual content, statistical analysis, obtaining funding and studying architect and supervision.
Supported by NIH/NIDDK R21DK095186-01A1, Nos. 3U54 CA091408–09S1, U54RR026140/U54MD007593, and UL1 RR024975; Research Foundation, American Society of Colon and Rectal Surgeons, Limited Project Grant (LPG-086).
Conflict-of-interest: The authors confirms of compliance with ethical and legal obligations including but not limited to compliance with ICMJE authorship and competing interests guidelines, that the article is neither under consideration for publication nor published elsewhere. This article is subject to blind, independent, expert peer review. The authors disclose no conflicts.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amosy Ephreim M’Koma, MD, MS, PhD, Department of Biochemistry and Cancer Biology, Meharry Medical College School of Medicine, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208-3599, United States. amkoma@mmc.edu
Telephone: +1-615-3276796 Fax: +1-615-3276440
Received: March 14, 2015
Peer-review started: March 16, 2015
First decision: April 10, 2015
Revised: April 24, 2015
Accepted: May 8, 2015
Article in press: May 11 2015
Published online: June 25, 2015
Abstract

Patients with indeterminate colitis (IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microscopic visual predict precision of eventual ulcerative colitis (UC) or Crohn’s colitis (CC) which is not offered in 15%-30% of inflammatory bowel disease (IBD) patients even after a combined state-of-the-art classification system of clinical, visual endoscopic, radiologic and histologic examination. These figures have not changed over the past 3 decades despite the introduction of newer diagnostic modalities. The patient outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis may be painstaking if IC turns into CC. Our approach is aiming at developing a single sensitive and absolute accurate diagnostic test tool during the first clinic visit through endoscopic biopsy derived proteomic patterns. Matrix-assisted-laser desorption/ionization mass spectrometry (MS) and/or imaging MS technologies permit a histology-directed cellular test of endoscopy biopsy which identifies phenotype specific proteins, as biomarker that would assist clinicians more accurately delineate IC as being either a UC or CC or a non-IBD condition. These novel studies are underway on larger cohorts and are highly innovative with significances in differentiating a UC from CC in patients with IC and could lend mechanistic insights into IBD pathogenesis.

Keywords: Indeterminate, Ulcerative, Crohn’s colitis, The colitides, Proteomics, Diagnostic accuracy

Core tip: This Editorial is introductory, dedicated to a novel and innovative study with clinical relevance regarding precision of indeterminate colitis (IC) into accurate diagnosis of either ulcerative colitis (UC) or Crohn’s colitis (CC). To date, it is very difficult to predict the clinical course of IC, whether it will evolve into UC or CC. About 90% of IC is diagnosed at the time of colectomy for fulminant colitis and subsequent management critically depends on the correct eventual diagnosis. The outcome after colectomy and pouch anastomosis may be painstaking if IC turns into CC. The undergoing studies of proteomic analysis on colon biopsy specimens, if successful will permit delineate IC into UC or CC precision which could be of great help in decision making regarding treatment indication. Although the present data is convincing and support differentiated between UC and CC, this data requires validation and confirmation on a large scale by clinical studies. Hopefully, this editorial will stimulate research into this field to trying to overcome the diagnostic accuracy challenges in inflammatory bowel diseases.