A string of high-profile research studies underscores the early successes of the Jill Roberts Institute for Research in Inflammatory Bowel Disease, where scientists are assiduously investigating the root causes of the disease. Now, with the official opening of its permanent laboratories, the Weill Cornell Medicine institute is poised to lead the way in advancing research to improve patient care.
Established nearly two years ago with a generous gift to Weill Cornell Medicine from longtime benefactor Jill Roberts, the institute uses a multidisciplinary approach to drive and then translate discoveries into new preventative and treatment strategies for IBD, a group of chronic inflammatory conditions of the intestine that affects an estimated 3.5 million people worldwide.
"We're in a very powerful position to accelerate basic discoveries and translate them to benefit patients," said Dr. David Artis, director of the institute and the Michael Kors Professor in Immunology at Weill Cornell Medicine. "That's really what all of this work revolves around: understanding these diseases so that we can treat and prevent them to improve the quality of life of the people who suffer from these diseases every day."
The institute and its five primary investigators have already made advances in describing the molecular underpinnings of IBD, exploring how host genetics, the immune system, the microbiota and pathways that control inflammation influence the disease's development and progression. In recent studies published in top-tier journals such as Science, Nature, Nature Medicine, Nature Immunology and PNAS, scientists have shown how the intestines repair themselves after daily attacks from microbes and other environmental triggers; a defect in this repair system contributes to IBD. They've revealed how the immune system learns to ignore beneficial bacteria in the gut while recognizing, eliminating and remembering foreign and harmful microbes that invade our bodies. Investigators have also discovered that starving immune cells of key nutrients prevents them from causing inflammation and allergies.
The institute's newest recruit, Dr. Iliyan Iliev from Cedars-Sinai in Los Angeles, investigates the fungi that colonize the intestine and how it operates in both healthy and unhealthy intestines — findings that researchers hope they can ultimately leverage into new therapeutic targets.
The close collaboration between researchers at the Roberts Institute and clinicians at the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medicine and NewYork-Presbyterian is enabling the institute's scientists to "translate life to the laboratory," notes center Director Dr. Ellen Scherl, applying patients' experiences of disease to research questions — and eventually, "transforming laboratory discoveries back into patient lives."
Research at the institute, in conjunction with physicians in the Jill Roberts Center, is helping to personalize treatment for IBD patients. While patients have historically been sorted into two categories of IBD — Crohn's disease, which is characterized by inflammation in the gastrointestinal tract, and ulcerative colitis, in which inflammation is localized to the colon — scientists are beginning to understand that many more subtypes of the disease may exist. They are recording and studying how each patient's immune system and microbiota is different, and how individual patients respond to treatments. The research will help to stratify patients into increasingly specific categories so that clinicians can deliver tailored, targeted and successful care. It will also enable physicians and scientists to capture changes in the disease and its manifestations —including joint and bone pain, and inflammation in skin, the eyes and liver — in individual patients over the course of their care.
"The gastrointestinal tract is the source of all inflammation in IBD, but there are many different manifestations that patients experience," said Dr. Scherl, who published a review article on Crohn's disease in the March issue of Current Gastroenterology Reports. "What makes our center and institute unique is that we can examine the systematic inflammation that our patients live with every day and investigate what makes their gut immune response different. We can do this cross- sectionally and longitudinally, characterizing our patients."
The institute and center are also building a new IBD patient live cell bank that will provide deeper insight into disease subtypes and how best to treat them. Consenting patients who receive care at the center provide samples of blood or tissue biopsies, from which researchers isolate and freeze immune cells they can later use to investigate the disease. The institute has so far collected 300 samples from adult IBD patients, and the establishment of a pediatric IBD live cell bank is well underway.
The research and clinical arms are also jointly embarking on a clinical trial, led by Drs. Carl Crawford and Vinita Jacob, that is testing fecal microbial transplants to treat ulcerative colitis. The goal is to replace unhealthy microbiota in colitis patients with microbiota from healthy patients to treat the disease. This approach is used successfully to treat Clostridium difficile colitis, a condition in which the aggressive bacteria C. difficile grows vigorously in the intestines and causes severe inflammation. The study, now approved by the U.S. Food and Drug Administration, will begin yielding data later this year.
"This clinical trial is a cutting-edge intervention attempting to ascertain whether this could be a new approach to treating IBD," Dr. Artis said. "These types of joint approaches have benefited enormously from the partnership between the Roberts Institute and the Roberts Center. We have also joined forces with other outstanding institutional experts in digestive diseases housed in the Center for Advanced Digestive Care and The Jay Monahan Center for Gastrointestinal Health. Together, we are in the unique position of having strengths in basic research and clinical care across multiple digestive diseases, coupled with a large patient population, and we hope that these partnerships will be very fruitful moving forward."
To celebrate these accomplishments and future initiatives, the institute hosted a ribbon-cutting ceremony on March 17 to celebrate the opening of its permanent laboratory space on the seventh floor of the Belfer Research Building. Speakers including Jessica Bibliowicz, chairman of the Weill Cornell Medicine Board of Overseers, Dr. Augustine Choi, the Weill Chairman of the Weill Department of Medicine, and Drs. Artis and Scherl voiced their excitement about the institute and their deep gratitude for Jill Roberts' continued generosity towards IBD research and care.
"The institute's leadership in this field is forging a path to an understanding of IBD's molecular underpinnings in order to translate basic research breakthroughs into advanced therapies for our patients," Bibliowicz said. "There is so much that's going to change because of the work that's happening here. Jill's dedication and David's great leadership have empowered the institute's incredible work to spearhead these efforts and to transform treatment for the many patients who suffer from IBD."