54 Figure 3 | Potential clinical applications of antibody profiling in inflammatory bowel disease. Serological antibody profiling could aid in the development of data-driven biomarker combinations for a variety of clinical outcomes in patients with IBD. Adding novel serological antibodies with proven discriminative capacity for IBD subtype (i.e. differentiating between CD and UC), disease behavior (e.g. differentiating between a fibrostenotic or penetrating disease phenotype), disease location or extent (e.g. differentiating between ileal-localized vs. colonic disease involvement in CD or left-sided colitis vs. pancolitis in UC), or the presence of perianal disease would be of great clinical value compared to current clinically-driven classification systems such as the Montreal classification (1 and 2). Furthermore, novel serological antibodies could be investigated for their potential to discriminate between quiescent and active IBD or even their ability to forecast fluctuations in the ‘relapse–remitting’ disease course typically observed in IBD (3). Serological antibodies could also help predict individual responses to medical and surgical interventions in IBD (4 and 5). For this purpose, it is likely that combinations of specific antibody reactivities may confer predictive potential in the foreseeable future. Similarly, the risk of surgical interventions and/or the risk of post-surgical complications could be predicted in early phases using selections of serological antibodies. Finally, in-depth profiling of serological antibody responses may improve early detection of disease onset (pre-diagnostics), which may open up possibilities for early intervention or disease prevention (primary and secondary prevention strategies) (6). Chapter 2
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