Crohn’s disease is a type of inflammatory bowl disease (IBD) that can take place anywhere in the digestive tract. According to the Centers for Disease Control and Prevention (CDC), prevalence of IBD in the U.S. is estimated to be roughly 3 million people. Unfortunately, IBD, as well as treatment, have both steadily increased in the last few years. Specifically, Crohn’s disease affects up to 300 people for every 100,000 in North America. Individuals of any age can be diagnosed but is common in patients between 15 years old to 40 years old. Those of northern European ancestry are also at greater risk as well as non-Hispanic white individuals. Symptoms of Crohn’s disease include abdominal pain, diarrhea, nausea and vomiting, fistulas, weight loss, and others. Although this disease affects many people, half the diagnosed population can become resistant to therapy. Scientists are working to understand more about this disease and develop stronger therapies to combat symptoms and improve quality of life.
A recent paper in Gut, by Dr. Sandra Kim and others, demonstrated that a protein-based therapy reduces fistulas in children, which can become extremely deleterious and debilitating. Kim is a physician and faculty member associated with the Cleveland Clinic and University of Michigan, respectively. She is a member of the Pediatric Gastroenterology, Hepatology, and Nutrition Department and specializes in IBD of children and adolescents. Her work focuses on new therapies and treatments targeted toward children and how to best alleviate symptoms.
Kim and her team used a protein-based therapy known as a cytokine-based therapy, which helps direct cell functions. Cytokines are proteins that are sent between cells to communicate. Many of these proteins are associated with inflammation and are critical in the body’s regulation of immune responses. The cytokine Kim and her team took specific interest in is known as tumor necrosis factor (TNF). This cytokine regulates the immune response and mediates inflammatory reactions, including cellular activity. TNF is a critical protein needed for inflammation; however, in Crohn’s disease, it is upregulated and causes chronic inflammation. Previous work has showed that blocking TNF can ease and alleviate Crohn’s disease symptoms.
Researchers found that early intervention through TNF blockade (anti-TNF) reduced perianal fistulas. This discovery is novel because it is the first time scientists are demonstrating that anti-TNF is the direct cause of reduced perianal fistulas. Children with Crohn’s disease are at higher risk of developing perianal fistulas, which are tunnels that develop near the anus and cause discomfort and may elicit the need for surgery to properly excrete stool. Unfortunately, perianal fistulas can also cause infection and cause organ damage. These deleterious effects often occur in children and are difficult to treat. Therefore, early treatment or prevention is ideal. This report from Kim and others followed over 900 recently diagnosed children that were given anti-TNF. Consequently, treated patients were more responsive to other therapies and reduced the likelihood of children developing perianal fistulas by 82%. This work helps inform physicians how to better treat their pediatric patients and improve quality of life.
Paper, Gut, Sandra Kim, Cleveland Clinic, University of Michigan
