Inflammatory bowels diseases (IBD) is a serious and long-term condition for patients, many of whom suffering from diarrhoea, belly cramps and rectal bleeding (amongst other symptoms). During the disease course, symptoms usually worsen if left untreated, and therefore patients are undergoing regular colonoscopies to monitor disease progression and adjust treatments. During the procedure, small tissue pieces are often collected by the medical team to determine the severity of the condition in different areas of the colon. Currently, the causes and factors influencing disease progression are not fully understood. Much research is needed to classify IBD states at a refined grading to make the medical treatments more effective. Our research attempts to increase knowledge on disease states in different areas of the gut and how these are connected to other conditions in the gut, such as the bacteria that live at these sites. To validate our suspicions (“hypotheses” in scientific terminology) we needed tissue samples of high-quality.
Photographer Dr Katarzyna Sidorczuk
Therefore, we teamed up with Miss Brunton-Sim and Miss Prior from Norwich Research Park Biorepository, as well as Prof Andrew Douds from the Norfolk and Norwich University Hospitals in 2021 to draft a plan for our research project. We agreed on collecting biopsy samples, tiny tissue pieces from the lining of the gastrointestinal tube of IBD patients. These biopsies contain the gut mucosa, the interface between our gut and the community of bacteria that are native to our body. These samples can help us understanding a) how the composition of different human cells changes along the gut in IBD patients of different disease states and b) what bacteria are typically involved in this process. To answer both of these questions we had to develop and optimize several protocols in our lab, to assure that we could reach the appropriate data quality and to warrant working with human samples. This development was done on mice samples, and once we had this protocol we started working with the combined team to collect human biopsies (tiny pieces of tissue that are often taken during all kinds of colonoscopies).
To study the natural conditions, our final protocol required getting biopsy samples fast – within 1 hour of being donated by the patient. This was a logistic challenge: imagine trying to recruit a patient to the study on the same day as the biopsy being taken and then to process it immediately after the procedure finished. This required having someone in our lab on stand-by to potentially receive samples, as well as having the procedure early enough in the day, having all the newly prepared reagents, labelled collection tubes etc. ready. Our stand-by teams needed to be ready for these samples several days a week and often enough samples could not be taken during the procedure. Luckily we had several people in our lab working together to enable this, Dr Ansorge, Ms Cerk and Ms Del Castillo Izquierdo foremost amongst these.
Photographer Dr Katarzyna Sidorczuk
Starting this complicated sample collection logistics required everyone to be on the same page, and we therefore organized monthly catch-up meetings with all involved parties. This allowed us over time to optimize sample collections and reduce the workloads: at the beginning of a month, the Biorepository team coordinated with the clinicians and us the patient recruitments, naming potential dates for collections, and then sorting a priority list to reduce the number of “stand-by” days for our team. We had our telephone contacts and could thus stay in close contact with each other, thus knowing when a patient agreed to the study and when to expect potential biopsies for processing. Later during the month, the Biorepository team would also take care of getting medical and questionnaire derived metadata for patients, collating this for us to be used in the data analysis.
Towards the end of the study, our teams had gotten used to work very efficiently together and operations was smooth; similarly our protocols had been optimized and Prof Douds knew our study questions by heart, thus often collecting additional information about tissue states, disease progression, of which he knew we would most likely ask about later. At this point it became a real team effort and a challenging task became much more manageable; it was a smooth experience at this point. Even after the study concluded, we still had a few ideas that we wanted to discuss, and the Biorepository team was enthusiastic to help us with these and in the end get us better study data.
After 3 years of working together on this, I can say that I would work anytime with the team at Biorepository again, they went beyond what was required of them to make the work more manageable for all involved. Case in point: we recently submitted a proposal together to work together again, and hopefully this will lead to more joint projects in the future.