CHARACTERISING THE MOLECULAR BASIS FOR PERIANAL FISTULIZING CROHN’S DISEASE

Perianal fistulae are a common complication of Crohn’s disease and can affect up to 50% of patients with Crohn’s disease. Fistulas represents a tract or passageway that’s created between two epithelial-lined surfaces often in most cases perianal, but also can be entero-enteric or recto-vaginal. Perianal fistulizing Crohn’s disease is thought to represent a distinct phenotype of Crohn’s disease and it often predicts a more extensive and complicated disease course associated with increased need for immunosuppressive therapy or surgery. Perianal fistulas can present with a number of debilitating symptoms for patients often resulting in a significantly impaired quality of life, in relation to both physical and psychological well-being. 

Penetrating inflammation in the rectal mucosa has been hypothesised to play a role in fistula formation, but the cellular and molecular basis of this has not yet been studied in great detail. In collaboration with the Fistula Research Unit at St Mark’s Academic Institute, we are working to characterise the immunological and biological processes that underlie perianal fistulizing Crohn’s disease using high-dimensional techniques such as multiparameter flow cytometry and big-data driven “omics” technology. Furthermore, we are using this information to understand how we may better target new and emerging therapies to patients by identifying new biomarkers that predict response to treatments such as mesenchymal stem cell (MSC) therapy.