Crohn's disease - On the horizon

In this section you can take a closer look at some of the promising areas of research and development:

Stem cells

What is it?

Scientists believe stem cells, which have the ability to become any type of cellThe basic unit of all living organisms. in the body, have the potential to treat and even cure Crohn's disease.

How does it work?

Stem cells could be used to repair the damaged bowel.

A stem cellThe basic unit of all living organisms. transplant into the bone marrowTissue within the bones where blood cells are formed. could also re-boot the immune systemThe organs specialised to fight infection., taking it back to a state before Crohn's disease was triggered.

What stage of development has it reached?

Scientists have begun work in animals and have shown that stem cells taken from the bone marrowTissue within the bones where blood cells are formed. appear to protect the bowel from autoimmuneAny condition caused by the body’s immune response against its own tissues. attack. Many more safety studies are needed before the same approach is routinely used in patients. Trials have begun with patients with Crohn's disease, and have yielded very promising results.

Meanwhile, scientists at The University of Nottingham in England are investigating whether stem cellThe basic unit of all living organisms. markers could have a role to play in speeding up wound healing in patients with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. In the future, it may be possible to use therapies to manipulate the expression of these markers attached to the cells to promote even more rapid healing.

Stem cells, which have the ability to become any type of cellThe basic unit of all living organisms. in the body, have the potential to treat and even cure Crohn's disease

Genes and gene therapy

What is it?

Experts know there is a strong geneticRelating to the genes, the basic units of genetic material. element to Crohn's disease.

What is the aim?

Scientists hope that if they can pinpoint the genes responsible they will be better able to identify and treat Crohn's disease and even cure people of the condition using geneThe basic unit of genetic material carried on chromosomes. therapy.

How does it work?

Gene therapy corrects the faulty genes that cause disease.

What stage of development has it reached?

Scientists have linked 32 geneticRelating to the genes, the basic units of genetic material. variations to Crohn's disease. One of the most promising is thought to be the CCR6 geneThe basic unit of genetic material carried on chromosomes., which is involved in the pathway that causes white bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. cells in the gut to become over-active, leading to inflammationThe body’s response to injury.. The latest Crohn's disease geneThe basic unit of genetic material carried on chromosomes. region to be uncovered is called NLRP3.

Researchers expect to uncover more as they continue their search because Crohn's disease is likely to be caused by many genes interacting with environmental factors.

New drugs

What is it?

Investigators are searching for new medicines to treat Crohn's disease.

What is the aim?

To control the symptoms, maintain disease remission and prevent relapse.

What stage of development has it reached?

The standard medicine for Crohn's disease works by blocking a molecule called tumour necrosis factor alpha, which regulates the immune systemThe organs specialised to fight infection. cells involved in inflammationThe body’s response to injury.. Scientists have created the next generation of anti-TNF medicines, including certolizumab pegol which was approved in the US in 2008. And even newer therapies are targeting other biochemical factors involved in the immune response.

The first non anti-TNF biologic medicine, called natalizumab, which is a humanized monoclonal IgG4 antibodyOne of a group of special proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. directed against alpha-4 integrin, was approved in 2008. Other medicines such as visilizumab, daclizumab and basiliximab stop specific immune cells, called T-cells, from responding.

Two other new medicines, tocilizumab and fontolizumab, prevent the formation or activation of T-cells. Another medicine targeting T-cells, called CCX282-B, is in the advanced stages of clinical testing.

Meanwhile, other research is looking at the possibility of making a personalised medicine made from the tissue of a patient's colonThe large intestine..

Nutritional and complementary treatments

What is it?

Many people look for approaches to healing other than conventional medicine, especially when orthodox treatments produce severe side effects or fail to improve symptoms.

Who is it for?

Any patient who wants to try a therapy in addition to conventional treatments that their doctor would normally use.

What stage of development has it reached?

There are many different approaches being explored.

A major challenge with Crohn's disease is impaired nutrition because the diseased bowel may not absorb enough of the nutrients the body needs.

This can be made worse by the diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. that is a common symptom of Crohn's disease. For this reason, people with Crohn's disease are advised to eat a healthy diet and may need to take extra vitamins as supplements.

The use of the herb boswellia has been suggested to relieve the bowel inflammationThe body’s response to injury., although there have been few trials or studies to provide evidence for this.

UK researchers are investigating whether an extract from plantain, a close relative of banana, can treat inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis..

Researchers in China believe retinoic acid, a form of vitamin A, could treat IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. It may help to treat the inflammationThe body’s response to injury. associated with IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis..

There is some research that suggests synbiotics may offer relief to people with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. These contain live microorganismsOrganisms that are too small to be seen with the naked eye, such as bacteria and viruses. or "good bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell." that will grow in the gut.

Other investigators believe a procedure called extracorporeal photopheresis, or ECP, may help. During the therapy a small proportion of the patient's white bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. cells is collected for re-injection back into the patient after treatment with a drug that, once activated by ultraviolet light, encourages the cells to commit suicide.

Risk factors/triggers

What is it?

The exact cause of Crohn's disease is not known but certain factors appear to increase an individual's chance of developing the condition.

Environmental and geneticRelating to the genes, the basic units of genetic material. factors appear to be important. For example, doctors know that smoking greatly increases the risk of developing Crohn's disease.

What is the aim?

Scientists are continually looking for more risk factors and triggers so they can more accurately diagnose, treat and prevent Crohn's disease.

What stage of development has it reached?

Many genes linked to Crohn's disease have already been identified and experts believe there remain many more to find.

In Crohn's disease, the immune systemThe organs specialised to fight infection. attacks the bowel and scientists are beginning to untangle why this is. Many believe bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. in the gut could be to blame, by triggering an abnormal immune response. Scientists have found some evidence to suggest a bacterium called Mycobacterium paratuberculosis, which causes a similar illness in cattle, may also be linked with the development of Crohn's disease in humans. Other studies have linked bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. like E. coli to Crohn's disease.

Some researchers believe the disease may result from malfunctioning phagocytes - the cells in the body that ingest and destroy foreign invaders. Some studies suggest that this defect could be driven, at least in part, by a polymer of a type of sugar known as mannose. Blocking this sugar may help to prevent Crohn's disease.

Meanwhile, other work has looked at a protein called GLI1, which is involved in the development of the gastrointestinal tractThe gut, which begins at the mouth and ends at the anus. in the foetus. Errors in this protein may be linked with the later development of inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis..

Scientists have found some evidence to suggest a bacterium called Mycobacterium paratuberculosis, which causes a similar illness in cattle, may also be linked with the development of Crohn's disease in humans

Disease surrogate markers

What is it?

A surrogate marker is something that can be readily measured to give an accurate picture of how the disease is progressing.

What is the aim?

The aim is to find a measure that is quick, cheap and easy to monitor and that is a direct reflection of Crohn's disease severity.

This would allow doctors to monitor the treatments they give to see if they are really working and spot when they need to intervene further.

What stage of development has it reached?

Scientists have identified a marker that is present in faeces, providing the possibility of a non-invasiveAny test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. test. Levels of this marker, called faecal S100A12, are increased if there is significant bowel inflammationThe body’s response to injury.. Similarly, faecal calprotectin has been proposed as a marker of inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Another potential marker found in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. is CXCL16.

Diagnostics

What is it?

Despite advances in radiological imaging and endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system., it can still be difficult to diagnose inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Accurate and early diagnosisThe process of determining which condition a patient may have. is essential, not least because the treatment and prognosis of ulcerative colitis and Crohn's disease differ.

What is the aim?

Experts are looking at ways to improve existing diagnostic methods, such as endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system. and magnetic resonance imagingA technique for imaging the body that uses electromagnetic waves and a strong magnetic field., and to find new tools, such as early disease markers in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. or faeces.

What stage of development has it reached?

Scientists are finding more and more targets in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. that could be used to flag up if someone is showing early signs of the disease. On the horizon are several techniques involving CTA scan that generates a series of cross-sectional X-ray images. (computerised tomographyA scan that generates a series of cross-sectional X-ray images.) and MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. (magnetic resonance imagingA technique for imaging the body that uses electromagnetic waves and a strong magnetic field.), potentially in combination with PET (positron emission tomography) imaging, to improve these scans' diagnostic potential. In particular, experts believe MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. or CTA scan that generates a series of cross-sectional X-ray images. enteroclysis could help with diagnosing some of the common complications that can occur with Crohn's disease, such as fistulas and abscesses. It entails infusing a special liquid dye, called contrast that shows up well on scans, through the nose and into the small bowel. The scans can then show how the contrast moves through the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus..

Detecting cancers - biomarkers

What is it?

Patients with Crohn's disease have an increased risk of colonThe large intestine. cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and for this reason scientists are looking for ways to spot those patients at the greatest risk and monitor them for the earliest possible signs of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., to enable treatment before the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. progresses.
Cancers of the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. also are more common in people with Crohn's disease, but the overall risk of this remains very small.

What is the aim?

Currently, detection of early cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in patients with Crohn's disease involves repeated colonoscopies, where a camera is inserted into the bowel. But these examinations are often incomplete and inaccurate. Scientists are hunting for biomarkersA substance that can be measured to help healthcare professionals to assess normal processes, disease processes or a person's response to treatment. - substances in the body that can be measured easily in the lab - that are highly predictive of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

How does it work?

People with Crohn's disease could be screened for the biomarker and those found to possess it could be monitored more closely and undergo treatment for any early signs of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

What stage of development has it reached?

Numerous research teams are searching for geneticRelating to the genes, the basic units of genetic material. biomarkersA substance that can be measured to help healthcare professionals to assess normal processes, disease processes or a person's response to treatment. to improve cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. surveillance. Others are looking for immunologic markers, such as antibodiesSpecial proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. against certain proteins found in cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. and precancerous cells.

Avoiding complications

What is it?

The most common complicationA condition that is linked to, or is a consequence of, another disease or procedure. of Crohn's disease is an obstruction or blockage in the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. because of swelling and scar tissueA type of connective tissue that forms after a wound heals. formation. Another complicationA condition that is linked to, or is a consequence of, another disease or procedure. is sores or ulcers within the intestinal tract that become so deep they turn into fistulas - tunnels that connect to nearby tissues such as other loops of intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. or the bladderThe organ that stores urine., vagina or even the overlying skin.

What is the aim?

Doctors are looking for ways to spot which patients are most likely to go on to have complications so they can intervene at the earliest stage and bring a person's disease under control more quickly.

How does it work?

Again, experts are looking at ways to improve existing diagnostic methods, such as endoscopyExamination of the inside of the body using a tube equipped with a light source and either a small camera or an optical system. and magnetic resonance imagingA technique for imaging the body that uses electromagnetic waves and a strong magnetic field., and to find new tools, like early disease markers in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. or faeces.

What stage of development has it reached?

New studies have linked specific biomarkersA substance that can be measured to help healthcare professionals to assess normal processes, disease processes or a person's response to treatment. to particular subtypes of inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. For example, anti-flagellin antibodyOne of a group of special proteins in the blood that are produced in response to a specific antigen and play a key role in immunity and allergy. (CBir1) has been linked with Crohn's disease in the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. complicated by fistulas, perforations, and other serious problems. Some markers are already being used by some doctors to help with diagnosisThe process of determining which condition a patient may have. and to measure disease activity and response to treatment.

Minimising drug side effects

What is it?

Although the drugs used to treat inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. are usually effective, not all respond and some people may find them difficult to take because of side effects.

What is the aim?

Scientists are looking at ways to work out which patients are most likely to benefit from which drugs, in order to target existing treatments to those people most likely to respond and so avoid the risk of unnecessary side effects.

What stage of development has it reached?

Scientists have been focusing their efforts on the most commonly used immunosuppressantA drug that suppresses the immune system, reducing the body’s resistance to infection. drugs in inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis., azathioprine and 6-mercaptopurine (6-MP).  They have been looking at monitoring the active end products of these drugs, called thiopurines called thiogaunine nucleotides or TGNs. Experts believe they can measure TGNs in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. to predict which patients are unlikely to respond to these drugs, so that they can change over to another type of treatment as soon as possible.

Improving existing treatment regimes

What is it?

Experts are looking at new ways to use existing therapies, including new formulations with altered delivery and new dosing regimens.

What is the aim?

Either to reduce the unpleasant side effects that can cause patients to discontinue their treatment or to make particular treatments more effective.

What stage of development has it reached?

One group of scientists is developing an "intelligent pill" that could enable some of the more powerful IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. drugs to be delivered directly to the affected area of the bowel, in order to limit side effects. Similarly, new colonic release corticosteroid formulations may help to limit steroid toxicity. Scientists are also investigating whether basiliximab, a drug that blocks a cellThe basic unit of all living organisms. receptor called IL-2, might reduce steroid resistanceThe ability of a microbe, such as a type of bacteria, to resist the effects of antibiotics or other drugs., which can be a problem for some patients with Crohn's disease.

Surgeons are looking at ways to refine the operations so they provide the best possible outcomes and the least trauma for the patient

New surgical techniques

What is it?

Most people with Crohn's disease will need surgery at some point in their life because of the nature of the disease.

Surgery may be needed to correct strictures (narrowing of the bowel), abscesses (walled in collections of pus), perforations (holes), fistulae (abnormal connections between tissues), haemorrhages (bleeds) and even cancers.

What is the aim?

Surgeons are looking at ways to refine the operations so they provide the best possible outcomes and the least trauma for the patient.

How does it work?

In the past, surgery mainly involved invasive operations that required the removal of whole sections of the affected bowel. Surgeons are now more often able to perform operations laparoscopically, using keyhole surgeryA type of minimally invasive surgery. instead. They are also able to preserve more of the bowel by using different techniques such as strictureplasty. With strictureplasty, surgeons leave the affected length of bowel in place but widen the narrowed, diseased part.

What stage of development has it reached?

New techniques are being championed all the time and as surgeons learn and try out these new skills they will become more widely available.

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