Exploring Fungal Biomarkers as Predictors of Treatment Response in Ulcerative Colitis Patients Receiving Anti-TNF Therapy

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease, is a chronic immune-mediated condition marked by recurrent intestinal inflammation. Although anti-TNF therapies like adalimumab (ADA) have improved disease management, predictive biomarkers for treatment response remain limited. Emerging evidence highlights fungal biomarkers as potential indicators of therapeutic outcomes, especially in UC. This study investigates fungal load dynamics and their association with clinical response in UC patients receiving ADA. Methods: We analyzed samples from 23 UC patients and 20 healthy individuals. Using quantitative PCR (qPCR), we measured the prevalence and DNA copy numbers of key fungal species, then assessed their relationships with disease activity, response to ADA, and inflammatory markers. Patients were further stratified by disease phase (flare-up vs. remission) and treatment response. Results: Our findings revealed an increase in Candida albicans levels in UC patients on ADA compared to healthy controls, while Candida glabrata was significantly reduced. Among the UC group, C. tropicalis showed the most marked increase during flare-ups compared to remission. When comparing treatment outcomes, non-responders exhibited notably higher levels of C. glabrata and C. tropicalis than responders. Further analysis suggested that disease phase may influence the relationship between fungal burden and treatment response, particularly for C. tropicalis . Conclusion: These findings reveal distinct fungal profiles associated with UC activity and response to adalimumab. C. tropicalis may indicate disease flare-ups, while elevated C. glabrata levels could reflect treatment resistance. Further studies are needed to validate fungal biomarkers as tools for guiding UC management.