Medical Advances in Crohn's Disease

From high-tech biologic drugs to ugh-inspiring yet anti-inflammatory worms

If you’ve recently been diagnosed with Crohn’s disease, you are, in a way, lucky. You have the condition at a time when there are better ways to treat it than ever before and a wealth of promising research is in the works. “In the next decade we’ll have a larger palette of choices to offer patients and their doctors that includes not only more complex drugs, but also ways that people might be able to monitor their condition and make changes to keep it under control,” says Jonathan Braun, M.D., Ph.D., professor and chair of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and a member of the National Scientific Advisory Committee of the Crohn’s and Colitis Foundation of America (CCFA).

Here are the breakthroughs that have gotten us where we are today in treating Crohn’s disease, plus a sneak peek at future ones.

Customized treatment. Picture this: You walk into your doctor’s office, give a sample of blood and/or saliva and walk out with a prescription for a specific food to eat and medications that have been individualized to meet the needs of your genetic makeup. Within a few weeks, your Crohn’s symptoms improve dramatically—and possibly disappear.

“Studies are increasingly validating the hypothesis that the reason people respond to certain drugs and not others is determined by their individual genetic makeup,” says Dr. Braun. “Currently there are more than 30 known genes associated with Crohn’s disease, and more are being identified each year.” In the future, doctors hope to be able to determine which genes a particular Crohn’s patient has and then match that genetic profile with drugs that have been proven to work best for that person.

There’s a second reason—or actually trillions of them—that you may or may not respond to a certain treatment for Crohn’s disease: the bacteria in your digestive tract. “Each of us has 500 to 1,000 different species of bacteria living in our intestines,” says Dr. Braun. Some are good for the digestive tract (helping to process food), others are neutral and some are bad. The latter are believed to possibly help turn a genetic susceptibility to Crohn’s disease into actual symptoms by activating the immune system. More than a dozen research institutions in the United States are currently studying intestinal bacteria, and are working toward creating a “bacterial dashboard” that will be used to identify and monitor a person’s bad and good intestinal bacteria. Simple prototypes of this diagnostic tool are now being developed and evaluated in animal studies. Once validated and refined for the complexity of human bacteria, a bacterial dashboard potentially could be used for clinical management of Crohn’s disease. “We could even imagine that a patient may be able to monitor her intestinal bacteria at home, and depending on specific changes, adjust her diet or get a prescription for a probiotic or an antibiotic to bring her intestinal bacterial makeup to a healthy balance.” says Dr. Braun.

Biologic wonders. One big breakthrough in Crohn’s research occurred in 1998, when the first biological therapy, infliximab (Remicade), was introduced. Infliximab is an antibody that blocks tumor necrosis factor (TNF), a molecule that cells use to talk to each other; in the case of Crohn’s, TNF is thought to tell other cells to increase inflammation in the digestive tract. “Neutralizing TNF calms the cells and restores peace in the intestines,” says Dr. Braun. Three other biologic drugs have since been approved by the FDA for treating Crohn’s disease—adalimumab (Humira), natalizumab (Tysabri) and the newest one, certolizumab pegol (Cimzia)—and there are at least 20 others in the research pipeline.

Drug combos: Strength in numbers. Can combining biologic medications with other drugs used for Crohn’s disease work better in controlling the disease than using either type of medication alone? Scientists have been researching that question for years and are starting to get some answers. Recent studies from Europe, Canada and the United States tested the combination of methotrexate with TNF blockers. (Methotrexate, originally developed as an anti-cancer drug, is FDA-approved for Crohn’s disease.) These studies found that the combination of methotrexate with TNF blockers can be more effective than either drug alone. The issue ahead is to determine ways to best define the benefit-versus-risk balance (such as a potentially greater risk of infection or cancer for an individual patient).

Pop (parasite) pills. A colorful approach to treating Crohn’s disease is based on the fact that until improved hygiene and other health advances came into play, the human body was typically host to intestinal parasites. Rather than causing harm, these microscopic worms had a calming effect on the immune system—the parasites’ way of keeping their home and food supply as healthy and accommodating as possible. Based on this knowledge, researchers at Tufts University in Medford, Mass., introduced parasites into the bodies of Crohn’s patients (the subjects ingested pills containing parasite eggs). In the first such study, 21 of the 29 subjects went into remission. The second study had similar results, and now other work is underway to determine if worm ingestion is safe, and whether parasites can actually work as a therapy in Crohn’s disease to reduce intestinal inflammation.

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