Nutrition therapy helps most children

UPI summarises a report in the Journal of Pediatric Gastroenterology and Nutrition that states that 60% of children with Crohn's will enter remission if they take a special nutrient mixture. This is as effective as steroids, and much preferable to the side-effects of long-term steroid use. However, it's a big commitment for the children:

Maintaining remission may require receiving 25 percent-50 percent of caloric intake by nutrition therapy -- sometimes for years, Shamir says. Children experiencing the treatment need the support of physicians, dietitians, psychologists and their families, the study says.

Although the reason that this works is not known, the fact that it works well and without side-effects makes it a great choice for children. Its benefits for adults are not mentioned, but one hopes that those studies are in process.

Early results for Crohn's cure

The Guardian reports that initial results from the first ever controlled stem cell trial (blogged previously in 2007, before the trial started) are very encouraging, with the leader of the trial expressing an expectation that half of the subjects will be cured.

Given the potentially fatal side-effects of the treatment it will only be an option for those most severely afflicted:

The stem cell treatment, which takes two years, is very painful for patients, and involves risks including bleeding, infection and a 1-2% chance of death. The stem cell transplantation is used to kill off the patient's old bone marrow that produces the harmful cells which cause the Crohn's and generate new healthy cells.

In reality it's far too early to consider a cure for Crohn's, especially as we still do not know the cause of the disease. Only long-term follow-ups of the stem cell trial participants will indicate its success as a cure. However, given the dangers in this treatment it is still not an option for the majority of sufferers, and so the research continues.

Infliximab and Azathioprine combo works best

In October last year I noted a report that Infliximab worked better than Azathioprine, and their combination worked better than Azathioprine alone. A new report in Forbes about a larger, lengthier study confirms the earlier report, and finds that the combination of drugs is significantly more effective than either alone.

After 50 weeks, 72.2 percent of patients who'd received the infliximab/azathioprine drug combination were in steroid-free remission, compared to 60.8 percent who'd received infliximab alone and 54.7 percent who had taken azathioprine alone, according to a Digestive Disease Week news release.

Of additional interest is that the subjects of the study commenced their medication regimes earlier in the disease's progression than is usual. The success of this treatment may influence when these drugs are used in future.

Would you like some worms with that?

Bearing in mind that "the plural of anecdote is not data", CBS has a report on a couple of Crohn's patients who attribute their reduced symptoms to self-administered hookworms. As it is not an approved therapy in the US it is quite an adventure to obtain.

Aglietti, who calls himself a gastrointestinal ecologist, takes clients across the border where he gives them a band aid to put on their arm.

On the gauze on the band aid, there is hookworm larvae.

Scots said he experienced some itching where the band aid was, which he understood, was the larvae making their way into the blood stream.

What happens next is the hookworms then travel from the blood stream into the lungs, where once there, causes the patient to naturally cough. Patients then cough the microscopic helminthes up into the throat, then swallow them, and this is how hookworms get to the intestines, where they latch on, and they begin to mature.

There are few ongoing studies into the use of hookworms to treat Crohn's. If it was shown to be successful then scientists would try to isolate the mechanism of its action. This should lead to a safer treatment using controlled medications, rather than live animals. I'm sure that would be much easier to swallow for many people.

More Crohn's genes found

There hasn't been much Crohn's news for the past few months, but I expect it to pick up around conference time. In the meantime The Children’s Hospital of Philadelphia has released information about a new technique for finding genes associated with a given disease. The researchers have tested this in the area of Crohn's and already found new genes related to the disease.

In a complex disorder such as Crohn's disease, many different genes interact to cause the illness. Research over the past few years have identified many of the genes with the strongest effects, but many other genes with important roles may produce weaker or ambiguous signals in the large-scale studies, and go overlooked.

For children and adults with Crohn's disease, who suffer the debilitating effects of chronic gastrointestinal inflammation, the emerging gene data may open the doors to more effective treatments. "Blocking cell receptors at some points on a biological pathway may produce clinical improvements, but with side effects to the immune system," said Baldassano. "If we can block other molecules further downstream on a pathway, we may achieve better treatments that may be more specific to an individual patient, with fewer side effects."

The full research is available in The American Society of Human Genetics (pay to view).

Monoclonal Antibody Decoder

I've created a simple online tool, the MAB Decoder (see the top right of this page) to decode the generic name of any monoclonal antibody. For example, type in the common Crohn's medication infliximab to find from which animal species it is derived, and what part of the body it acts upon. This can be important because human-sourced antibodies are often better tolerated than those from other animals, which may influence your choice of medications. New monoclonal antibodies are being generated all the time, and often you'll see some new ones mentioned in passing. With this tool you simply enter their names to be able to learn more about them.

The MAB Decoder works with generic rather than brand names. Humira, for example, should be entered as adalimumab (the generic name of monoclonal antibodies always end in -mab). Incidentally, it is useful to be familiar with generic names because brand names may vary from country to country.

You can read more about monoclonal antibody naming at Wikipedia.

Although I created this tool to investigate Crohn's drugs, it will decipher monoclonal antibody names for all conditions. You can also try creating your own names, like humungofungomab!

October summary of biologics

Medscape [direct link requires subscription] has released a new summary of the latest findings in biologic therapy for Crohn's disease. Their previous summary on recent anti-TNF research was in June. Although that's still well worth reading, there have been much activity in this area since then.

This article discusses combination therapies, first-line therapy (i.e. should biologics be used earlier in the treatment regime), switching biologics if they become ineffective, safety and newer biologics which have only recently been approved for use. Most of these have been reported in detail previously, but it's handy to have them summarised in one place.

A missing bacterium?

According to the BBC French researchers suspect that a low level of Faecalibacterium prausnitzii bacteria in the intestine could be the cause of Crohn's disease.

The researchers, from the Institut National de la Recherche Agronomique, had already shown that patients with Crohn's disease have a marked deficiency in bacteria from the Clostridium leptum group.

Their latest work shows that F. prausnitzii - a major component of this group - accounts for a large part of the deficit.

If this is true, then treatment would be a simple course of specific probiotics to boost the levels of the bacteria. However, this research is only at the level of cells in test tube. It still has the difficult hurdles of animal and human trials to come.

It's interesting to note that probiotics and antibiotics are both being proposed as possible cures for Crohn's. Although this sounds contradictory, they could both be successful. The probiotic may encourage the growth of certain "good" bacteria which work against "bad" bacteria, whereas the antibiotic works solely on eliminating the "bad" bacteria.

Infliximab more effective than Azathioprine

The Associated Press reports on research that shows Infliximab (Remicade), used alone or in combination with Azathioprine (Imuran) is significantly more effective, and no less safe, than a treatment of just Azathioprine.

Currently, doctors usually prescribe Azathioprine first, and only progress to Infliximab when that fails. This study indicates that Infliximab should be considered earlier. (Note that this study was financed and run by the producer of Infliximab.)

There is more coverage at MedPage Today.

The anti-Crohn's diet

There have been plenty of anecdotal reports of people who have successfully controlled their Crohn's by following specific diets. The Daily Mail mentions the success of a thousand patient trial in a UK hospital.

(...) At Addenbrooke's Hospital, gastroenterologist Professor John Hunter and his team identify foods that act as a 'trigger' for symptoms, eliminate them from a patient's diet and 'switch off' the disease.

Now 90 per cent of his patients are symptom-free and 56 per cent can resume a normal diet after five years.

During the first phase of treatment, patients consume only specially formulated drinks.

'They contain all the nutrients a patient needs, already broken down into their most simple constituent elements so the body does not have to do any work digesting them,' explains Professor Hunter.

'By taking the gut out of action, we effectively switch off the disease. After two to three weeks, 90 per cent of patients find their symptoms have disappeared.'

They then gradually reintroduce different foods to determine which will cause flare-ups in the individual.

This is the first reasonably large trial of using diet alone to control Crohn's that I've heard of. However, it really needs to be expanded into a much larger scientifically-controlled trial to truly ascertain its effectiveness. Unfortunately, most trials are funded by drug companies, and a diet solution to Crohn's wouldn't offer any profit for them. On the other hand, I'm sure there would be no shortage of volunteers for the trials, and doctors willing to assist.