JAK-STAT pathway targeting for the treatment of inflammatory bowel disease

Nat Rev Gastroenterol Hepatol. 2020 Jun;17(6):323-337. doi: 10.1038/s41575-020-0273-0. Epub 2020 Mar 19.

Abstract

Cytokines are involved in intestinal homeostasis and pathological processes associated with inflammatory bowel disease (IBD). The biological effects of cytokines, including several involved in the pathology of Crohn's disease and ulcerative colitis, occur as a result of receptor-mediated signalling through the Janus kinase (JAK) and signal transducer and activator of transcription (STAT) DNA-binding families of proteins. Although therapies targeting cytokines have revolutionized IBD therapy, they have historically targeted individual cytokines, and an unmet medical need exists for patients who do not respond to or lose response to these treatments. Several small-molecule inhibitors of JAKs that have the potential to affect multiple pro-inflammatory cytokine-dependent pathways are in clinical development for the treatment of IBD, with one agent, tofacitinib, already approved for ulcerative colitis and several other agents with demonstrated efficacy in early phase trials. This Review describes the current understanding of JAK-STAT signalling in intestinal homeostasis and disease and the rationale for targeting this pathway as a treatment for IBD. The available evidence for the efficacy, safety and pharmacokinetics of JAK inhibitors in IBD as well as the potential approaches to optimize treatment with these agents, such as localized delivery or combination therapy, are also discussed.

Publication types

  • Review

MeSH terms

  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / immunology
  • Crohn Disease / drug therapy
  • Crohn Disease / immunology
  • Cytokines / immunology*
  • Humans
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / immunology*
  • Intestines / immunology
  • Janus Kinase Inhibitors / therapeutic use
  • Janus Kinases / immunology*
  • STAT Transcription Factors / immunology*
  • Signal Transduction / immunology

Substances

  • Cytokines
  • Janus Kinase Inhibitors
  • STAT Transcription Factors
  • Janus Kinases