Inflammatory bowel diseases (IBD) are chronic and debilitating immune-mediated conditions affecting the gastrointestinal tract, which include Crohn's disease (CD) and ulcerative colitis (UC). Both conditions exhibit a relapsing-remitting pattern with varied phenotypes and disease progression. Ongoing advances in understanding the molecular mechanisms behind pathogenic inflammatory processes have led to the emergence of targeted therapies. However, precision medicine in IBD remains in its early stages. Approximately one-third of patients are primary non-responders to initiated treatment, and half of patients lose response over time. Furthermore, rates for surgery because of complicated disease remain extremely high in CD (approximately 20-30% at 10 years after diagnosis). Similarly, patients affected by UC can develop rapidly progressive and severe or multi-refractory forms of disease. Non-invasive monitoring through serological and faecal biomarkers, and through surrogates of endoscopic activity (i.e., ultrasonographic parameters) represents currently the backbone of the management of IBD patients. Still, the complex and multifactorial pathogenesis, the heterogeneity of patients, the variable and unpredictable course of disease hamper the identification of reliable clinical, molecular or serological predictors.

Therapeutic decisions are currently guided by disease-related factors, comorbidities, safety considerations, drug characteristics, and patient preferences, but their predictive reliability is low. These factors serve merely as surrogate indicators and are insufficient for guiding clinical practice, emphasizing the need for predictive molecular biomarkers to determine the most appropriate treatment for each patient.

The goal of this Research Topic is to present innovative discoveries in the identification and validation of novel biomarkers in IBD, for IBD, which may serve as indicators of biological processes and can be applied in clinical practice to optimize therapy selection for patients with the highest likelihood of response. We here focused on research data for prediction of both therapeutic response/resistance as well as for disease course including the development of extra-intestinal manifestations, fibrosis and complications. This collection will help to refine strategies in managing patients with IBD, highlighting the possible beneficial effects of personalized approaches and reducing the time spent on ineffective treatments and minimizing the risk of adverse events. In the near future, an ideal approach will involve combining complementary biomarkers through multimodal analysis, integrating genetic, microbial, transcriptomic, proteomic, metabolic, and immunologic data to achieve a fully personalized approach.

In this Research Topic collection, we aim to investigate the identification, development, and validation of new biomarkers to enhance personalized treatment strategies in pre-clinical studies and in clinical settings in the management of IBD. We encourage submissions of Original Research, Review, Mini Review, and Perspective articles to explore the following specific questions, but not limited to:

• Genetic biomarkers of disease course, progression and therapeutic response in IBD.
• Microbial and/or luminal biomarkers of disease course, progression and therapeutic response in IBD.
• Transcriptomic biomarkers of disease course, progression and therapeutic response in IBD.
• Innovative biomarkers for predicting therapeutic response to anti-TNF agents, ustekinumab, vedolizumab, JAK inhibitors, and/or anti-IL-23 antibodies.
• Molecular pathways conferring therapeutic resistance in patients with IBD.
• Innovative biomarkers for predicting extra-intestinal involvement/s in patients with IBD.
• Innovative biomarkers for predicting intestinal fibrosis in patients with IBD.

Topic Editor Dr. Olga Nardone is in receipt of lecturing fees from Ferring, Abbvie, Janssen, Eli Lilly, Pfizer, AlfaSigma, Noòs and is on the advisory board for Nestle. Topic Editor Dr. Rocío Ferreiro-Iglesias has served as a speaker for or has received research funding from Takeda, MSD, Abbvie, Janssen, Pfizer, Palex, Shire Pharmaceuticals, TillottsPharma, Faes, AdacyteFerring and Casenrecordati. Topic Editor Dr. Arianna Dal Buono has served as a speaker from MSD, Abbvie, Pfizer, Ferring and Celltrion.

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Frontiers in Immunology

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