May 2, 2024 – More than 1 million Americans live with
Crohn’s,
a chronic and sometimes crippling inflammatory bowel disease that affects the intestines and leads to digestive issues. While some people may have mild symptoms or even be symptom-free at times, others experience severe symptoms such as belly pain, diarrhea, fatigue, weight loss, anemia, and other life-threatening complications.
Currently, there is no cure for Crohn’s disease, and available treatments are often limited. Common drugs used to treat it, like steroids and immunosuppressants, can provide relief and slow disease progression. However, many patients find that these drugs become less effective over time or may not work at all. While surgery is an option in some cases, both patients and healthcare professionals are actively seeking new therapies that can alleviate symptoms and improve quality of life.
In recent years, there has been a significant focus on finding solutions for IBD in general and Crohn’s disease specifically. With increased research funding, gastrointestinal experts across the U.S. are testing new medications that target inflammation and autoimmune reactions, as well as exploring fecal transplants to improve gut flora.
In 2024, several promising developments have been announced, offering potential relief in various ways. Researchers in California, for example, are working on a stem cell therapy that could help heal the intestinal lining and trigger a positive response from the immune system. While the therapy has shown positive results in animal studies, human clinical trials are still needed. This therapy could be beneficial for patients who do not respond well to standard treatments or the latest medications.
“In the last decade, several new therapies and biologics have been introduced for IBD, but these treatments carry risks of side effects, and only about half of patients show a response. Those who do respond may lose that response over time,” said Maneesh Dave, MD, an associate professor of medicine in gastroenterology and hepatology at the University of California, Davis.
Studying Stem Cells
Dr. Dave, leading the stem cell therapy research at UC Davis, highlighted concerns with current medications. Severe side effects, such as blood clots, and suppressing the immune system, leading to higher infection risks are common. To address these issues, Dave and his team are researching solutions to increase response rates and minimize side effects by focusing on treating inflammation and promoting gut healing.
In a study published in January in npj Regenerative Medicine, Dave and colleagues investigated how human bone marrow-derived mesenchymal stem cells (hMSCs) could heal inflammation in mice with a chronic small intestine inflammation resembling Crohn’s disease. The results showed mucosal healing and an immune response even after the hMSCs were no longer present.
“These cells have the potential to suppress the immune system and regenerate the intestinal lining, which is very promising,” Dave stated. While similar treatments are approved in Europe, further research and clinical trials are needed in the U.S.
As research continues, Dave warned IBD patients against seeking treatments at unregulated stem cell clinics with unproven therapies. The FDA has not approved any stem cell treatments in this area, and these experimental treatments could lead to serious complications.
Feeling the Flare-Up
During Crohn’s disease flare-ups, individuals often experience belly pain, diarrhea, and blood or mucus in stool. Northwestern University researchers have developed a wireless implantable temperature sensor to detect inflammatory flare-ups, aiming to prevent or minimize damage caused by prolonged inflammation.
“Changes in temperature are indicative of inflammation, and persistent inflammation can lead to significant tissue damage and systemic disruptions,” said Arun Sharma, PhD, a research associate professor at Northwestern’s Feinberg School of Medicine and McCormick School of Engineering.
In a study published in March in Nature Biomedical Engineering, Sharma and his team tested a temperature sensor against the intestines to track disease progression and flare-ups in mice with Crohn’s disease. The sensor successfully tracked changes in temperature over several months, indicating the size of the flare-up based on heat signatures. This could enable early intervention for patients rather than waiting weeks for traditional samples.
The researchers plan to conduct further tests with human tissues mimicking inflammatory conditions seen in Crohn’s disease. These sensors could also benefit individuals with ulcerative colitis or other conditions involving prolonged inflammatory responses, like organ transplants.
“Real-time monitoring of flare-ups could greatly enhance quality-of-life metrics for those affected,” Sharma noted. “This advancement has the potential to revolutionize patient care and outcomes.”
Caring for Kids
Specialists in the U.S. and Canada focusing on pediatric IBD patients are collaborating through the CAMEO Study to find improved treatments for children. This research aims to understand why some children receiving standard anti-tumor necrosis factor (anti-TNF) medications achieve mucosal healing, while others do not.
“Few studies have explored Crohn’s disease therapy specifically in children, and all existing drugs on the market are based on adult studies,” explained Dr. Neal LeLeiko, a professor of pediatrics at Columbia University. LeLeiko emphasized the importance of finding the best anti-TNF dosing for children to ensure efficacy and safety.
Therapeutic drug monitoring plays a crucial role in assessing treatment effectiveness in children, as dosing adjustments based on weight and healing progress are essential for optimal outcomes. LeLeiko stressed the importance of safe and effective drug use, especially in pediatric populations.