Student and Faculty Narrative Review Published in Yale Journal
Discover how St. Matthew’s University academic community members are supporting Inflammatory Bowel Disease research.
At St. Matthew’s University School of Medicine (SMUSOM), we are committed to helping students develop the knowledge, skills and strategies needed to conduct effective medical research projects and contribute meaningfully to the international body of research in medicine.
As part of the 10-semester Doctor of Medicine (MD) program, students must complete and submit a mandatory and graded research project. During this process, participants are tasked with writing a research proposal for a systematic review of a current medical topic. Importantly, they learn to formulate relevant questions and hypotheses, research published literature, and critically evaluate their findings.
Recently, two MD program students, Jatniel Servian and Brianna Brady, combined their focus on targeted biologic therapies and worked with three faculty members to publish a research review, titled Pharmacoepigenetic Biomarkers in Inflammatory Bowel Diseases: A Narrative Review. As a testament to its relevance and quality, it was published in the Yale Journal of Biology and Medicine!
To learn more about the group’s efforts and findings, we connected with faculty member Stephanie King, PhD, who was kind enough to answer our questions and provide some interesting insights.
How did this group of faculty members and students come together to author the article, and what sparked their interest in this topic?
“This project began when Jatniel Servian and Brianna Brady were both in their first year at St. Matthew’s University, where students are required to develop a topic for a research review. Both Jatniel and Brianna did an excellent job and were chosen to present at Research Day, receiving Certificates of Excellence in Research Achievement. Jatniel’s research project was on the pharmacogenetics of asthma biologics, while Brianna investigated stem cell therapies for Crohn’s disease patients who did not respond to other forms of therapy.
Both Jatniel and Brianna’s research projects had a similar theme: the urgent need for more targeted biologic therapies for autoimmune and inflammatory disorders. I have a background in epigenetics, and I saw an opportunity to merge their ideas together in a novel review on pharmacoepigenetics, a rapidly emerging field that investigates the use of epigenetic data to predict patient treatment outcomes. To strengthen the review, I recruited my colleagues, Pritam Biswas, MD, and T.K. Sukumar, MD, for their expertise in pharmacology and immunology, respectively.”
Please provide a brief summary of the article and share why it is important for the current field of medicine.
“Our review, Pharmacoepigenetic Biomarkers in Inflammatory Bowel Diseases (IBD), investigates how epigenetic modifications, such as DNA methylation, histone modifications and noncoding RNAs, can serve as predictive biomarkers of treatment response in IBD. Many treatment protocols for Crohn’s disease and ulcerative colitis require patients to go through a “fail-first” step therapy, where several less expensive treatment options are trialed first before patients can be approved by insurance to receive more effective (but expensive) medications called biologics. This approach causes significant delays in effective treatment, increasing the risk of irreversible intestinal damage.
Although the American Gastroenterological Association recently released guidelines that recommend biologics as first-line therapy in the management of moderate to severe IBD, clinicians still face the challenge of predicting which biologic will work with each given patient, demonstrating a need for a personalized medicine approach. While there have been some studies indicating the use of genetic markers to determine which biologic therapies would be effective, the development of autoimmune conditions like IBD is largely controlled by environmental factors, not genetic inheritance, and therefore cannot effectively be investigated through genetic testing.
Our review suggests using epigenetic markers as a promising alternative to predict treatment outcomes. Epigenetic states change over the lifetime, reflecting influences of the environment and disease-state. We believe that not only can epigenetic states predict which patients should receive biologic therapy immediately, but also which biologic medications should be prescribed on a patient-by-patient basis. Integrating epigenetic profiling as personalized medicine could reduce treatment delays and improve patient outcomes in IBD.”
Are there any new medical actions, processes or approaches that you hope to see implemented or considered based on your findings?
“We hope this review expands pharmacoepigenetic research into larger, more diverse populations. Studies conducted so far have been relatively small, and have low ethnic and geographic diversity, making these studies challenging to apply to worldwide populations. By generating interest in this promising new field, we hope to increase research funding and allow for larger, multi-center trials that give a better reflection of performance in a diverse group of patients.
Following the success of clinical studies, we predict epigenetic profiling will be combined with current diagnostic and monitoring tools, such as laboratory testing and endoscopic findings. We believe this advancement could reduce treatment delays, prevent unnecessary exposure to ineffective medication, and allow physicians to develop a personalized strategy for each patient.”
How did the learning environment and support systems at St. Matthew’s University support this initiative?
“At St. Matthew’s University, research is incorporated into the medical curriculum from the very beginning. During the first semester of the MD program, students take the Principles of Research and Evidence-Based Medicine course, where they are taught about literature databases, research ethics, study design, and the critical appraisal of research studies. They also begin to work on their own research project, which will eventually become their own literature review.
Having this project at the very beginning of the MD program experience is critical to fostering intellectual curiosity for lifelong learning in the field of medicine. At the faculty level, St. Matthew’s University also strongly encourages research and conference participation, and that students and faculty regularly collaborate on review papers like ours.”
Please briefly outline how each author contributed to this narrative review.
- “Jatniel Servian helped inspire the review and spark interest into the field of pharmacogenomics and pharmacoepigenomics, especially with biologic research. She contributed to writing the section about pharmacoepigenetics in inflammatory bowel diseases (IBD).
- Brianna Brady inspired how the review went into investigating the need for more targeted therapies in IBD. She contributed to writing the introduction section of the review.
- Dr. Pritam Biswas contributed to Current Treatments in IBD section and Table 1.
- Dr. TK Sukumar contributed to the Case for Epigenetic Biomarkers and Genetic vs Epigenetic Contributions sections, in addition to Table 2.
- I (Dr. Stephanie King) initiated and coordinated the review, edited all contributions, and contributed to the introduction, review of recent pharmacoepigenetic studies, future directions, and conclusion sections.”
Is there anything else you’d like to highlight about the findings or share about the authors?
“I would like to note that this authorship group is also a reflection of St. Matthew’s University’s culture of collaborative learning. What started out as student research projects eventually ended up as a multi-disciplinary publication in a great journal. This truly demonstrates how early research training with faculty mentorship can culminate in important contributions to biomedical science, and most importantly, foster the development of the next generation of physicians.”