Biologics for Stricturing Crohn's Diseases

Duobrii in Combination With Biologics

A single center, pilot study of 25 subjects to assess 12 weeks DUOBRII to patients with 2%-10% body surface area who are receiving biologic therapy for at least 24 weeks

Burst Biologics Spinal Fusion Registry

Spinal fusion surgery remains the most common intervention despite the increasing prevalence of various motion preservation and alternative stabilization devices for patients who are unresponsive to conservative treatment and experience back and/or leg pain and decreased function/quality of life. Donor site morbidity and availability limit the use of autogenous bone and over the past two decades' surgeon interest in alternative bone grafts has steadily increased. Bone morphogenic proteins, synthetic bone graft substitutes, and various allograft products are widely available to surgeons. Limitations on the use of allografts in the past were mainly attributed to less than optimal donor screening and processing techniques which removed viable components needed to aid in the bone healing process. In recent years, the focus and scientific advances in various allograft processing techniques have allowed the retention of various viable cytokines, growth factors, and cell populations which result in enhanced osteogenic and osteoinductive properties. Rigorous donor bone screening and meticulous testing has virtually eliminated the risk of disease transmission. A unique proprietary cryoprotection processing technique for allograft tissue was developed by Smart-Surgical, Inc. and a complete line of allograft products was created and is now marketed by Burst Biologics (dba). In addition, rigorous standardized laboratory assay techniques and statistical analysis provide consistency and uniformity of the biologically active components of Burst allograft products. This prospective registry was designed as an observational study to ascertain how commercially available Burst Products are being used by surgeons performing spinal fusion as well as determining relevant patient outcomes.

3TR Asthma Biologics Cohort (ABC) Study

The 3TR Consortium is the overall generator behind the 3TR-ABC study. The 3TR Consortium consists of 15 European countries and a total of 69 partners who collaborate on seven different autoimmune, inflammatory, and allergic diseases: chronic obstructive pulmonary disease, asthma, Crohn's disease, ulcerative colitis, multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis. The ambition of the consortium is to accelerate precision medicine by fundamentally increasing the knowledge of molecular pathways and mechanisms related to response and non-response to therapy. To date, the 3TR Consortium is the largest immunology project funded by the Innovative Medicine Initiative (IMI). The 3TR-ABC platform study is anchored in the so-called work package 8 (WP8) within the 3TR Consortium and will contribute with knowledge about the effect of biological therapies in severe asthma: With the advent of highly targeted biological therapies for severe asthma, several important questions arise; what determines a good clinical response versus non-response? Can we induce remission of severe asthma, and improve long-term outcomes? The 3TR-ABC study platform is a clinical trial platform and network, in which intervention-specific studies on different biologics are conducted. Via the 3TR-ABC study platform, conducting advanced translational studies in a real-life cohort of asthma patients is made possible, in collaboration with key opinion leaders and scientific experts in the field from across Europe. The 3TR-ABC study design includes a core study visit structure, which can be expanded or amended per study to suit individual focus points. Overall, the study design includes enrollment of bio-naïve patients with severe asthma, who have been assessed with systematic assessment, and who meet the criteria for commencing a biologic, according to national criteria in each country. Patients are then followed from the time of starting a biological treatment for three years, during which time they are followed at set time points as well as at the time of exacerbations, with sampling consisting of a core package and expanded packages, depending on the site. By using a range of state-of-the-art and novel methods for assessing immune activation, and applying advanced bioinformatics analysis methods, The investigators expect to be able to identify immune activation patterns and response profiles that will further our understanding of disease drivers in the treatment of refractory severe asthma. Furthermore, healthy participants and patients with mild/moderate controlled asthma will be acting as controls for baseline markers thus constituting a healthy as well as mild/moderate controlled asthma reference population. Benralizumab Cohort Study: The AIR-BIO-OCT study Allocation to biologicals occurs by means of asthma phenotyping including clinical parameters including OCS use and blood or sputum / bronchoalveolar lavage (BAL) eosinophils (reflecting Th2 high - Th2 low inflammation). It is unclear if and how biologics impact on airway remodeling and how they act within the airway wall and which airway cells are targeted in vivo, directly or indirectly by a reduction in eosinophils. Important pathophysiological features of asthma that relate to disease severity and prognosis are airway inflammation and remodeling, including an increase in airway smooth muscle (ASM) and extracellular matrix (ECM) alterations. Therefore, with the AIR-BIO-OCT substudy as part of the 3TR-ABC Study, next to performing a complete unbiased multi-omics approach the investigators also have some already identified multi-omics phenotypes within severe asthma that the investigators would like to investigate in a cohort of benralizumab users. As such extensive phenotyping before and after treatment, by combining exhaled breath VOCs (GC-MS and eNose) technology with minimal invasive omics (molecular) and innovative imaging technology by OCT, including polarization-sensitive OCT PS-OCT (impact of benralizumab on remodeling). Primary Objective Determine baseline biomarkers of remission after 1 year of biological therapy, defined as ACQ-5 <1.5, post-bronchodilator FEV1 percent predicted ≥80% OR >10% improvement as well as no exacerbations, or use of maintenance steroids for the past 12 months ("remission on treatment"). Secondary Objectives Determine baseline biomarkers of remission after 3 years of biological therapy. Additionally, i) Change in biomarker profiles in remission versus non-remission groups, ii) baseline and change in biomarker profile for a) each response outcome individually, b) Global evaluation treatment efficacy (GETE), patient and physician rated response, and c) 3TR agreed on a composite assessment of response, iii) determine the change in all response variables against baseline biomarker data and change in biomarkers as continuous variables. Exploratory Objectives: Novel analytical science approaches including but not limited to network and cluster analyses and partial least-squared discriminate analysis (PLSDA), topographical discriminant analysis of omic data derived from the biosamples collected at planned visits as well as daily FENO to determine possible novel biomarker signatures (including FENO) and relate to asthma remission, clinical response, interactomes of the multi-omic and clinical data, host-microbiome interactions. AIR-BIO-OCT substudy objectives Primary Objective: - To identify and measure an eNose/ volatile organic compound (VOC)- multi-omics extensive severe asthma phenotyping strategy before treatment with biologicals to reveal add-on response characteristics to better predict treatment response. - To identify and measure minimal invasive predicting "signature" of biological treatment response in severe eosinophilic asthma by extensive asthma pheno-endotyping using innovative minimal invasive exhaled breath technologies including eNose/VOCs and omics. Secondary Objective(s) - To measure airway remodeling (extracellular matrix and airway smooth muscle) after treatment with Benralizumab - Establish the reduction of extracellular matrix (ECM) and airway smooth muscle (ASM) by the standard - polarization-sensitive (PS) - OCT and endobronchial biopsy analyses after 6 months - 1 year of Benralizumab treatment. Study Design The 3TR-ABC study is a multicentre observational prospective cohort study that follows patients with severe asthma from the time of commencement of biological therapy and three years onwards. Healthy individuals and patients with mild/moderate controlled asthma are included as reference groups and will undergo the same baseline visit as patients with severe asthma. Informed Consent must be obtained from all participants who accept enrollment in the study in order to allow the collection of data and biological materials for the database and biobank, respectively. The study follows each patient with severe asthma at six visits over a period of three years. The first visit is the so-called baseline visit and is performed before the beginning of a biological treatment. This visit consists of a standard examination package, a site-specific extended package (i.e., tests in this package will only be done at specific sites), and an optional extended package (i.e., the participant decides). The remaining five visits are so-called follow-up visits and are made respectively 4 weeks, 16 weeks, 52 weeks, 2 years, and 3 years after the baseline visit. These visits consist of a follow-up sampling package and a site-specific extended package. An optional extended package is furthermore possible for the 4 weeks, 52 weeks, 2 years, and 3 years visits. Between scheduled visits, patients with severe asthma are asked to come for an extra visit if they experience a sudden exacerbation. Participants in the control groups will only be invited for the baseline visit. The AIR-BIO-OCT study is a sub-study within the 3TR-ABC Study performed in the Netherlands that will select severe eosinophilic asthma patients that start treatment with Benralizumab and will phenotype those patients (combining exhaled breath analysis and OCT technology) before and after 16 weeks and additional 52 weeks from the start of the biological. In the Netherlands, the AIR-Bio-OCT substudy consists of two parts: the first, aligned with the 3TR - ABC study, where samples of the abovementioned packages will be collected (n=34) and merged with the Benralizumab subjects recruited within the 3TR consortium (total 60-90 patients). The second part, additional bronchoscopy with standard and PS-OCT before and after 6 months-1 year will be performed (n=15).

BIOlogics in Severe Nasal POlyposis SurvEy

Biologics and Partial Enteral Nutrition Study

80 adult patients with active CD who are due to start biologic injections therapy with adalimumab as part of their standard of care for the first time will be recruited for this study. Patients will be randomly allocated to replace either half of their normal diet with nutritionally complete milkshakes or to follow their usual diet for 6 weeks. The investigators will compare the proportion of patients whose symptoms and disease markers will improve between the two groups at 6 and 12 weeks, and how many of them will remain symptoms-free for up to a year following treatment. The investigators will also explore whether the half-liquid diet will influence patients' nutrition and quality of life. Last, the investigators will investigate if gut bacteria changes and their metabolites associate with patients' eating habits and their responses to treatment with biologics. The primary aim of the BIOPIC study is to investigate if replacement of 50% of habitual food intake with a proprietary liquid diet for 6 weeks will improve remission rates at 12 weeks in adult patients with active ileocolonic CD treated with first-line biologics (TNFα antagonists, adalimumab) as their standard treatment of care. The secondary aim is to investigate if replacement of 50% of habitual food intake with a proprietary liquid diet for 6 weeks will prolong remission in adult patients with active ileocolonic CD treated with first-line biologics (TNFα antagonists) as their standard treatment of care.

Burst Biologics Foot and Ankle Registry

Foot and ankle surgery requiring the use of bone graft is common despite recent advancements and improved outcomes with new motion preservation devices (ankle replacement). Autogenous bone remains the gold standard but is complicated by donor site morbidity and availability of a sufficient volume of graft. Over the past two decades surgeon interest in alternative bone grafts has steadily increased. Bone morphogenic proteins, synthetic bone graft substitutes, and various allograft products are widely available to surgeons. Limitations on the use of allografts in the past were mainly attributed to less than optimal donor screening and processing techniques which removed viable components needed to aid in the bone healing process. In recent years, the focus and scientific advances in various allograft processing techniques have allowed the retention of various viable cytokines, growth factors, and cell populations which result in enhanced osteogenic and osteoinductive properties. Rigorous donor bone screening and meticulous testing has virtually eliminated the risk of disease transmission. A unique proprietary cryoprotection processing technique for allograft tissue was developed by Smart-Surgical, Inc. and a complete line of allograft products was created and is now marketed by Burst Biologics (dba). In addition, rigorous standardized laboratory assay techniques and statistical analysis provide consistency and uniformity of the biologically active components of Burst allograft products. This prospective registry was designed as an observational study to ascertain how commercially available Burst Products are being used by foot and ankle surgeons performing procedures which involve bone grafting, as well as determining relevant patient outcomes.

Biologics and Clinical Immunology Cohort At Sinai

The study team proposes a twofold approach to determine how immunophenotype may affect the course of clinical immunological disease for patients receiving biologic therapy. First, the team intends to establish a biorepository and database that includes demographic, immunologic, exposure and clinical records. The registry will be set up to facilitate research across disease disciplines, and across other registries affiliated with ISMMS. Second, over time, the team aims to address specific and an increasing number of research questions focused on using novel diagnostics to increase the effectiveness of biologic treatment as outlined below. Most subjects will be recruited from the Mount Sinai Therapeutic Infusion Center (TIC), although others receiving infusions elsewhere or at home will be recruited from outpatient affiliated clinical practices during scheduled medical visits. Specific Aims: 1. (Overarching) Build a repository of biological specimens, questionnaire data, and apply state-of-the-art assessment tools to assess the current immunological and clinical condition, and changes over time. Specimens and data will be collected in a manner that can readily incorporate new technology, new research questions, link to intelligent analytics, and provide a resource for future consortia across disciplines. An infrastructure will be created that includes a multi-disciplinary Steering Committee to facilitate spinoff research studies and harmonize protocols within the TIC and across the Sinai system, resolve procedural questions, and communicate updated policies to referring physicians. Additional initial specific scientific aims related to responses to biologics prescribed as part of standard practice that will be considered in this proposal are to determine: 2 . Effects of anti-IgE therapy on IgE phenotypes, maturation and production, and clinical outcomes. 3. Effects of anti-IgE and anti-IL-5 therapies on dopaminergeric pathways and clinical outcomes. 4. Effects of anti-TNF, anti-CD20, and other biologic therapies on immunological and clinical outcomes. 5. Effects of IVIG therapy on immunological and clinical course in Common Variable Immune Deficiency. Futures studies will focus on Clinical Decision Support (CDS), Artificial Intelligence, and use of technology to inform and educate current TIC patients. Future studies also will feature studies related to immunological and clinical responses to additional biological therapies. Background The prescription of biological agents and immune modulators to treat chronic immunological-based diseases continues to expand. This trend is predicted to continue. Applying data-driven and immunophenotype-driven approaches to their use could reveal additional pharmacologic targets and signal disease presence or relapse prior to the onset of clinical symptoms. These advances in precision medicine also may reduce adverse drug reactions and help control overall cost of healthcare associated with inefficient and 'trial and error' prescribing. They also may provide information on susceptible individuals and their appropriate care during healthcare crises, such as the current COVID-19 pandemic. Despite these developments, prospective studies and clinical trials that feature immunophenotyping to facilitate 'real world' therapeutic decision-making are limited. More comprehensive immunophenotyping has predicted clinical responses to cancer immunotherapy, suggesting that this approach may translate to immunologically-mediated nonmalignant diseases. But widespread application to multiple chronic diseases is limited by several research gaps. These include determination of: 1) new biomarkers (discovery, validation) that may inform clinicians of drug responsive endotypes, 2) biomarkers that predict disease course over time in replicate studies, 3) optimal methods to link immunophenotype with analytic diagnostic and clinical decision-making tools to predict disease course, 4) factors that mediate treatment responses, some of which may be modifiable (eg environmental exposures, viruses, disease phenotypes). The Mount Sinai Therapeutic Infusion Center is an ideal location where investigators have the potential to fill in many of these research gaps. The volume is large, with currently 1803 individuals actively (in 2019) receiving anti-cytokine or anti-CD20 biological treatment for their immunological, dermatological and neurological disorders, largely prescribed by members of the Divisions of Clinical Immunology, Rheumatology, Pulmonary, Inflammatory Bowel Disease (IBD), Neurology and Dermatology. Further, investigators across Divisions (Clinical Immunology, Rheumatology, IBD) and Departments (Medicine, Neurology, Dermatology) have created a research working group to discuss collaborations and standardized approaches to assessing immunological responses to biologics. This registry also intends to coordinate with other registries at ISMMS to ensure that it utilizes common approaches to biomonitoring and common data elements as much as feasible to facilitate comparisons across cohorts. Primary and Secondary Study Endpoints The initial scientific hypotheses focus on these endpoints: Aim 1 An expanded repository of biological specimens and questionnaire data. Aim 2 Measures of IgE phenotypes and associated clinical airway outcomes. Aim 3 Measures of changes in the dopaminergic pathway and clinical airway outcomes. Aim 4 Measures of anti-TNF, anti-CD20, and other biologic therapies on immunological and clinical outcomes. Aim 5 Measures of IVIG-induced immunological and clinical outcomes.

MRE Predictors of Disease Relapse After Stopping Biologics

This study aims to investigate if MR Enterography (MRE) improves the ability to predict which Crohn's disease patients will relapse (disease comes back) after stopping biologic medication when clinically well. MRE is a safe MRI scan of the bowel, widely used in Crohn's disease patients. Using a network of British Society of Gastrointestinal and Abdominal Radiology (BSGAR) affiliated NHS hospitals, up to 200 patients who have stopped biologic treatment and recently underwent MRE as part of usual care will be identified. Detailed analysis will be performed on these MRI scans using scores measuring residual bowel inflammation, and retrospectively collect standard clinical data such as blood, stool and colonoscopy results. Using hospital records (accessed by each local care team before being pseudoanonymised) the study will see what happened to patients after one year, specifically if they relapsed or remained well off the biologics. Based on a literature review, the most promising predictors of early relapse will be identified, such as blood/stool tests, to build a statistical model that provides the risk of a patient relapsing within one year. MRE scores will be added to this model to see if it improves the ability to predict relapse. The results of the study could form part of a clinical decision support tool to help risk stratify patients and improved joint management decision making.

Therapeutic Effect of New Biologics in Crohn's Disease