Breakthrough Treatments for Crohn’s Disease
Crohn’s Disease is a debilitating auto-immune disease that causes the body to attack the lining of the gut. Any part of the gut can be affected but commonly it affects the last section of the small intestine (ileum) or the large intestine (colon).
Crohn’s disease affects an estimated 1.4 million Americans and symptoms can include painful abdominal cramps, diarrhoea, constipation and intestinal bleeding. In severe cases, fistulas can develop cause further pain and complications.
However, recent developments may offer Crohn’s sufferers some optimism about treatment for their condition.
Researchers from Technische Universität München (TUM) have found that bacterial imbalances in the guts of mice can cause very similar symptoms to Crohn’s Disease (CD). The team noted that the mice, who were termed ‘germ-free’ due to a lack of micro-organisms living in or on them, developed Crohn’s Disease type symptoms when disease associated microbiota were transplanted into them.
The research team have concluded from their study that no single bacterium caused the symptoms in the mice but rather that a general composition of the bacterial communities within the intestines resulted in CD.
Study lead author, Professor Dirk Haller, TUM Chair of Nutrition and Immunology, noted that “Although we used mice that had an increased genetic disposition towards Crohn’s-type inflammation, they did not develop symptoms until we implanted the intestinal bacteria of affected animals.” Drawing from the study results Prof. Haller concluded, “It has a lot more to do with the bacterial communities present. It would appear that some combinations of bacteria are ‘dysbiotic’ – or imbalanced – and their characteristics can now be explained.”
The study also looked at the properties of Paneth cells and the intestine cell wall. This area is particularly important to understand as a characteristic of Crohn’s Disease. The death of Paneth cells was found to be after ileitis development (inflammation of the gut) rather than it’s cause. Inflammation of the gut, caused by bacterial imbalances, is made worse by the death of Paneth cells.
Referring to fecal implants, Haller said “In most cases, the inflammation returns after a time. Stool transplants have already proven effective for a number of intestinal diseases. However, this unusual treatment has yet to deliver conclusive results in patients with Crohn’s disease and ulcerative colitis. The findings from our study will help provide a scientific basis for improving this approach – and then it could work.”
Where fecal transplants are being used, health bacteria from a healthy patient are being used to colonize the intestines of Crohn’s Disease patients in an effort to create healthier environments with ‘better’ microbes. 9 teenage patients with mild to moderate symptoms were given fecal transplants via nasogastric tubes. The results seemed to be positive with 7 out of the 9 in remission 2 weeks after treatment. 5 of these remained in remission 6 and 12 weeks later.
Where fistulas have developed in a C.D. patient, experimental stem cell treatment is now being tested. Reports of Crohn’s patients, in Korea, being treated with cells from their own fat tissue have provided hope that complications from fistulas could be successfully treated. In a surgical procedure, stem cells and surgical glue are combined in order to be injected directly into the fistula. Healing has been reported in 26 out of the 36 patients treated with fistulas remaining closed 2 years after treatment.
There are, of course, other clinical studies taking place. But there seem to be significant developments in this area of medicine, including reports in Nature Medicine of the development of a model of the human small intestine from pluripotent stem cells. Lab-grown intestine could help researchers understand intestinal complications better, whether they originate from genetic abnormalities or from illnesses, such as Crohn’s Disease and cancer, that develop in later life.
In your experience, do you think there is enough public and medical awareness about the complications of Crohn’s Disease?