'Thinking outside the box' — 3 GI leaders on how their Sherman Prizes will advance Crohn's, IBD research

The Bruce and Cynthia Sherman Charitable Foundation awarded Sherman Prizes to David G. Binion, MD, Jean-Frederic Colombel, MD, and Amy L. Lightner, MD.

The Sherman Prize recognizes "outstanding contributions in the fight to overcome Crohn’s disease and ulcerative colitis." Drs. Binion and Colombel were awarded $100,000. Dr. Lightner was awarded a $25,000 Sherman Emerging Leader Prize.

Dr. Binion is the University of Pittsburgh Medical School's IBD Center co-director and director of translational IBD research. He was recognized for his research on immunologic, cellular and physiologic alterations associated with Crohn’s disease and ulcerative colitis.

Dr. Colombel is a professor of medicine, director of the Leona M. and Harry B. Helmsley Charitable Trust IBD Center and Susan and Leonard Feinstein IBD Center at the New York City-based Icahn School of Medicine at Mount Sinai. Dr. Colombel has extensive expertise in building collaborative research teams to identify genetic causes of IBD, factors that impact disease progression and effective treatment strategies.

Dr. Lightner is an assistant professor of surgery at the Rochester, Minn.-based Mayo Clinic College of Medicine, and medical director of the Translation Into Practice Platforms at the Mayo Clinic's Center for Regenerative Medicine. Her research focuses on pushing the boundaries of minimally invasive surgery and exploring regenerative cellular and acellular therapies to help manage some of the most difficult complications of Crohn’s disease.

"This year's Sherman Prize honorees, Drs. Binion, Colombel and Lightner, have helped to transform treatment and surgical approaches so people with IBD are able to achieve better disease management and experience fewer complications than was thought possible even a decade ago," Bruce Sherman, one of the Sherman Prize founders, said in a statement.

A physician scientist living with Crohn's disease

Diagnosed with Crohn's disease as a teenager, Dr. Binion approaches patient care and research from the perspectives of both physician and patient.

"Having personally experienced many of the challenges brought on by IBD, I feel comfortable sharing my story with patients. The majority of individuals find solace in the knowledge that their physician has personally lived these issues and had to make the same decisions they are faced with regarding treatment and surgery. There is credibility when you can tell a patient you take the same medicines that they take," Dr. Binion told Becker's ASC Review. "Most importantly, I have an immediate bond with patients, having lived through similar challenges. It is very easy for me to diagnose a partial small bowel obstruction when talking with a person with Crohn’s because I know what this feels like."

At the University of Pittsburgh Medical Center, Dr. Binion built an IBD patient data registry to help discover new ways to identify patients at risk for the disease.

"Using patient data to improve outcomes is an essential part of today’s medicine and efforts to standardize and improve the quality of care. This is an important and natural goal in IBD care, but this has been extremely challenging, as we don’t have 'measuring sticks' to gauge clinical status and trajectories of clinical status in IBD over time," Dr. Binion said. "We have tried to craft solutions to these challenges by incorporating measures of disease activity and quality of life into our outpatient clinic encounters, so that we can readily and easily compare status from visit to visit."

Dr. Binion said he plans to use the funding from the prize to continue his efforts with big data analytics in IBD, which will entail integrating datasets involving diet, the microbiome and the metabolome and multi-year natural history trajectories.

"Being a Crohn’s disease patient has fueled my unwavering commitment to research, which is essential and the only way to make the lives of IBD patients better," he said.

A surgeon who wants to see fewer IBD surgeries

While Dr. Lightner loves to operate, she told Becker's ASC Review her goal is for patients to have fewer surgeries to treat IBD.

"When you do surgery for Crohn's, it's not curative; we're just treating symptoms. For a patient to have to undergo the morbidity of an operation and putting them out of work to not cure them is difficult. So, we fix their symptoms, but a lot of the time, their disease reoccurs. The goal is really to prevent them from having to undergo the morbidity of surgery," Dr. Lightner said.

While surgery may help patients' symptoms, it can be risky. Less invasive treatments can mitigate the risk of surgery, Dr. Lightner said.

"I love to operate and help these people feel better, but ultimately I think it's really about finding what's causing the disease and how we can treat it without surgery and give them a better quality of life. While the operating room makes them feel better, there is associated risk and it's a lot to go through. If we can find a way to prevent [the hardship] and treat [patients] in a more effective and less invasive way, I think that's a huge achievement."

In college, Dr. Lightner was pursuing a career as writer, but volunteering at a hospital reading program changed her trajectory toward medicine and science.

"I really liked being around the patients and seeing what they were going through and how they could get better by a physician helping them," she said. "It was almost like the doors opened to this whole new field that I really loved, and I found that I was really passionate about it."

Dr. Lightner came to the field of gastroenterology after studying immunology and finding interest in liver transplantation in medical school. In her lab at the Mayo Clinic, Dr. Lightner said she plans on using the funding for clinical trials in stem cell therapies for patients and studying regenerative products through a mouse model.

"I love that [gastroenterology] is one of the surgical specialties where you can really create a relationship with a patient, and follow them over the long term," Dr. Lightner said. "I think it really comes down to the relationships and feeling like you're making a difference."

A physician finding breakthroughs in IBD care through a team effort

Dr. Colombel's leadership brings together geneticists, microbiologists, epidemiologists, systems engineers and IBD clinicians to spearhead new concepts in IBD treatment through multidisciplinary research teams. His work focuses on the potential to predict and prevent Crohn's disease.

Dr. Colombel believes it may be possible to predict the onset of Crohn’s disease five years before the first symptom appears.

"If [Crohn's disease] isn't detected early, it is very difficult to stop. I believe we can control symptoms of IBD if we detect them early, but even in that case, it's quite difficult to stop or cure [Crohn's disease]," he said. "On top of that, the burden of IBD is increasing worldwide. There are more and more patients, and the cost of the disease is becoming unbearable for [them]. So, for all these reasons, I believe we should try to think outside the box. I think we should start thinking about prediction and prevention."

Dr. Colombel's research in prediction and prevention identified the first genetic risk factor for Crohn's disease and a new strain of E. coli (adherent invasive E. coli, or AIEC) that is associated with ileal Crohn’s disease.

Dr. Colombel said he will use the prize money to continue his research in IBD prediction and prevention.

"I will also organize the first IBD prediction prevention workshop in March 2019, where [clinicians] will exchange ideas and samples that will encourage collaboration," Dr. Colombel said.

The Sherman Prizes will be presented for the first time at the Advances in Inflammatory Bowel Diseases conference, Dec. 13 in Orlando, Fla.

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