Crohn's due to weakened immune system

The BBC reports on a Lancet study that indicates that Crohn's may be due to a "weakened immune system failing to destroy bacteria".

The UCL team compared the immune system response of Crohn's patients and healthy individuals to minor injuries, such as skin abrasions.

They found the Crohn's patients produced much lower numbers of infection-fighting white blood cells called neutrophils, and lower quantities of chemicals involved in the inflammatory process.

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The researchers believe that, because Crohn's patients have weakened immune systems, they are unable to destroy bacteria that penetrate the intestinal wall.

Thus the bacteria are left to build up in the tissue, stimulating the secretion of inflammatory chemicals that trigger the symptoms of Crohn's.

Forbes has further specific information:

Segal and his colleagues measured the number of neutrophils (white blood cells) produced by Crohn's patients in response to trauma in the bowel and on the surface of the skin.

Surprisingly, these patients produced 79 percent fewer neutrophils and inflammatory mediators compared with healthy individuals subjected to the same trauma.

When a harmless form of bacteria was injected under the skin, blood flow in healthy volunteers increased tenfold over 24 hours. But in people with Crohn's disease, blood flow increased only fourfold.

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But others feel that the work does not really break new ground. "There have been other studies in the last year or two that Crohn's disease is really a problem dealing with bacteria in the colon and the inflammation is set up because there's more of a defective immune response to the bacteria in the gut," said Dr. John Thompson, director of the division of pediatric gastroenterology and nutrition at the University of Miami's Miller School of Medicine.

The link between Crohn's and MAP

The Saturday Evening Post has an in-depth interview with leading researcher and advocate on the link between Crohn's and MAP, Dr. John Hermon-Taylor.

He explains why he believes there is a link between Crohn's and MAP and describes the success he has had in treating Crohn's patients.

Using the polymerase chain reaction (PCR) technique, you can show that virtually everyone with chronic inflammation of the Crohn's disease type is infected with the MAP bug. MAP is an organism that is a specific cause of chronic inflammation of the intestine in many different species of animals, including primates.

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There are now four open-label clinical studies carried out independently ... which essentially all say the same thing. That is, that somewhere between 50 to 75 percent of people with active Crohn's disease who can take rifabutin and clarithromycin treatment will get better and heal--sometimes like magic.

COX-2 inhibitors for pain-relief?

EurekAlert has a release about the results of two research programs into the use of COX-2 inhibitors by people with IBD:

Both studies examined the benefits of non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors, in a patient population with ulcerative colitis and/or Crohn's disease. Study findings show that NSAIDs were well-tolerated, with COX-2 inhibitors offering the most effective pain relief in this group.

MedPage Today has another summary:

... these studies imply that NSAIDs -- long thought to be absolutely contraindicated for patients with inflammatory bowel disease -- can be used safely in some circumstances

Sargramostim trial

Australia's ABC News is reporting that use of cancer therapy drug Sargramostim in trials for Crohn's disease is showing good signs:

... Dr Graham Radford-Smith from the Royal Brisbane Hospital says the outlook is positive.

'The important things are that this drug is very safe, it's got a long track record, it's been around for a long time, there have not been any major safety issues,' he said.

'We're yet to see what happens in terms of efficacy and that's obviously critical in the drug being successful in the treatment of Crohn's disease.'

According to the Yahoo Health Drug Guide:

Sargramostim is used to increase white blood cells and decrease the risk of infection in conditions such as cancer, bone marrow transplant, and pre-chemotherapy blood cell collection.

The New England Journal of Medicine has the full report of another trial of Sargramostim for Crohn's disease. Though the report costs money to view, the quite detailed abstract is free to read. Its conclusion was interesting:

This study was negative for the primary end point, but findings for the secondary end points suggest that sargramostim therapy decreased disease severity and improved the quality of life in patients with active Crohn's disease.