Crohn’s Stem Cells, Bone Marrow, and Cure?

Some good news came out of this press release. Dr. George McDonald of the Fred Hutchinson Cancer Research Center announced that they are starting a trial to look at whether bone-marrow transplantation can cure people who suffer from Crohn’s disease. Cure is always a deceptive word. As I learned in economics there are no cures only tradeoffs. The idea is to get the best possible result given tradeoffs faced.

The idea is to swap out the old immune system for a new immune system. The procedure known as allogenic hematopotietic cell transplantation has since the 1970’s.  However one of the major concerns has been the risks including side effects and possible death. According to this November 25, 2010 article in the New England Journal of Medicine 1418 patients received transplants from 1993-1997 while 1148 patients received a transplant between 2003 and 2007. Interestingly over time as knowledge improved and techniques got better mortality decreased overall by 52%. The people that were studied had some serious illnesses such as leukemia, multiple myeloma, and lymphoma (I don’t believe people with Crohn’s disease were studied). I suspect as time goes on the procedure will only become more effective and less risky just as other procedures do.

Some people claim this would be a cure for Crohn’s however I am skeptical of this. In this 2010, that George McDonald did 96% of patients did not relapse after 1 year, 63% at 3 years, and 36% at 5 years. This tells me that even though the immune system is rebooted so to speak that in time it becomes less effective. Although, I wonder if that 36% has anything in common. It would be interesting to study the genes of these people before the treatment to see how different people would respond to the treatment.

Crohn’s patients should welcome new trials as these may be helpful to Crohn’s patients around the world. However, at the same time we should be skeptical of procedures until many trials are done and their effectiveness is shown.

For more information on this trial click on this link

Remicade, Fecal Calprotectin, CRP, and Flare Up

Clinical evidence from this article that came from the 2012 Digestive Disease Week suggests that after patients were taken off Remicade. In the study CRP and faecal calprotectin calprotectin where used to predict whether or not a patient would get a flare up. Fecal calprotectin and CRP can be measured through a stool sample which is very easy to do.

Patients with high CRP and calprotecin levels were significantly higher in patients that relapsed. For example the patients that did not relapse had a CRP of 2.9 mg/L while the patients who relapsed had a CRP of 4.9 mg/L with a statistically significant P value meaning the results were not due to chance along). The fecal calprotectin was also vastly different. For people that didn’t relapse it was 58 mcg/g and 302 mcg/g for those that relapsed.

C-reactive protein is a measure of how much inflammation is in the body. People with colon cancer had a CRP of 2.69 mg/L which is actually lower than patients with Crohn’s. However, the average for people who don’t have colon cancer is only 1.97 mg/L which to me doesn’t suggest much of a difference. What is interesting however is patients with high CFP levels may benefit from statins (Lipitor). Perhaps Crohn’s patients should be in a trial should be run to see if Lipitor or other statins could help Crohn’s patients. Of course in science we always run the risk when looking at results of assuming cause and effect. Perhaps the patients that released in the study had some other factor that contributed to relapse.  If people with inflammatory bowel disease had a toilet like I mentioned in this post that could measure CRP and faecal calprotein in order to alter gastroenterologists quickly and perhaps leads to additional studies on patterns of when patients may get flare-ups.

Smart Toilet for Crohn's?

One invention for Crohn’s or ulcerative colitis patients that would be very valuable is a toilet that can analyze bowel movements. I saw this story about a toilet that can analyze the structure of a stool and send a URL to a patient. The toilet can analyze amount of bacteria, fat, and other important information. For Crohn’s patients and ulcerative colitis patients whether or not the stool had blood and whether or not it was solid or liquid. The results could be sent via toilet to the gastroenterologist who would have that information and get alerts if they saw a patient declining in their health. Hospitals would really benefit from this if they were able to do both stool and urine analysis in patient rooms and have the information sent to the attending physician who could review it. This way hospitals wouldn’t have to waste time giving people little cups or bags to analyze urine or stools. Whenever a patient used a toilet they would be providing data to the doctor and hospital.

The type of kind of data that could be generated with this new invention I believe would help not only Crohn’s and colitis patients but everyone in general. If a toilet was able to analyze to do a urine and stool analysis people could maybe see illnesses in diseases much more in advance and go to the doctor before they got worse. The CCFA should work with toilet makers and scientists in order to develop a toilet that can analyze urine and stool at the same rate as a high grade research laboratory. We literally are flushing valuable down the toilet every day!

Possible New Biomarker for Crohns?

Genisphere and Lankenau Institute for Medical Research will develop a biomarker for ulcerative colitis and Crohn’s disease. Hopefully this will help doctors better pinpoint what patients might actually have and classify to what degree people have inflammatory bowel disease. A paper said that the biomarker could classify the severity and outcome of ulcerative colitis and able to tell who had colitis compared to those people that were healthy. Better tests are needed for inflammatory bowel disease as we know a colonoscopy can be a pain in the butt (thank you I will be here all week). The test could also be applied to cervical cancer and wound healing. 

TiGenix Cx601 for Crohn's Better Than Remicade?

I wasn’t aware about this trial but apparently TiGenix announced that it was enrolling patients in a Phase III clinical trial for patients with perianal fistulas for Crohn’s. The treatment is a stem cell therapy with the patient using fat tissue from stem cells that is then injected into the fistula via injection. The trial should have about 200 Crohn’s patients who all have complex perianal fistuals. The trial took place ahead of schedule (results expected in 2014) which is good news. 

According to this press release from the company that had 24 patients enrolled with 2 that had to be withdrawn from the study but it could have been due to Crohn’s itself and not the disease. More than 56% of patients had their external fistula orifice close. Also according to this presentation was more than twice as effective as Remicade (56% compared to 23% for Remicade)

It would be interesting to see how this medicine would work for just regular Crohn’s patients. As I have mentioned before on this blog it takes many years to get a drug approved. The drug was given orphan status (meaning since the disease affects so few people it was expedited in clinical trials) yet I have no idea when this drug will be approved if ever in the United States. Once a drug is approved by a foreign country it should automatically be approved in the United States so the people that are suffering can benefit.

Smart Toilet for Inflammatory Bowel Disease and Crohn’s

One invention that I believe would be very useful for people with inflammatory bowel disease and Crohn’s is a smart toilet that can do a stool analysis. In general stool analysis could be used to examine whether or not someone was having diarrhea and see if there is any blood in the stool. Sometimes there could be blood inside the stool that is hard to see with the naked eye. Also a stool analysis can look at white blood cells, screen for colon cancer, and check absorption of nutrients. A stool analysis can also be used to look at the liver and pancreas which is a good health benefit. Combining this with a urine analysis test all within a toilet could be very valuable for not only people with inflammatory bowel disease but the general population.

When I was in the hospital I remember tests were done very often (blood was in the early morning) and urine tests throughout the day with a few stool tests. However, if a toilet within my room was able to be used to analyze my urine and stool and that information could be directly sent to the nurse and doctor but it would make the process much more efficient and maybe even cheaper. In essence if smart toilets were installed they would be more valuable then tests because every time a patient went to the bathroom information would be generated that would monitor how they were doing as opposed to asking for a test randomly. So much medical data is literally being flushed down toilets!

An idea would be for CCFA to partner with a maker of a smart toilet manufacturer to work with patients with inflammatory disease in a pilot study having the patients step up a smart toilet and having that information sent to their gastroenterologist. Patients would be monitored for a year to see how they are doing. Personally I have been managing my own symptoms with the GI Monitor App which is pretty neat. I have a feeling the more information will provide doctors a better idea of how the patient is really doing then even how they say they are doing. Even as patients it is hard to precisely pinpoint how we are doing. With this type of technology not only doctors but patients can be armed with knowledge and as we know knowledge is power. 

Vegetarian Diet and Crohn's

Study is here if you want. My favorite part is that remission was maintained in 94% of people who just did a semi-vegetarian vs. 33% who ate meat. Remission rate for the semi-vegetarian group was 100% at one year and 92% after 2 years. I would love for there to be a long term study of meat eaters, semi-vegetarians, and 100% vegetarians.

Saturday Study: Smoking and Crohn's

I think everyone knows how idiotic smoking is however people still do it. The reason this came to my mind was that many studies look at Crohn's patients over time but they never seperate out the patients that were smoking and not smoking. I would think the patients who don't smoke would get better results of most treatments and have fewer complications. Smoking however according to this report from the American Lung Association that shows that from 1965-2009 the annual prevalence of smoking declined 55%. 

When looking at the studies of how smoking effects Crohn's. This study showed that when examining the rates of needing additional surgery after 5 years for non-smokers was 20% while 36% for smokers. At 10 years the need for repeat surgery was 41% for nonsmokers and 70% for smokers. It seems as if the longer someone with Crohn’s smokes the more likely they are to require surgery. It seems as if smoking does increase the chances of requiring additional surgery. This study concluded that smokers have a higher increase in the risk of flare up. However, people that use to smoke have risks comparable to non-smokers. The policy recommendation therefore should be to not smoke and if you are smoking to stop smoking to decrease the chances of requiring surgery and also decreasing the chances of a flare up.

Top 10 Ways You Know You Have Crohn’s

1. You know where the closest bathroom is at all times

2. When you want to go to the bathroom you don’t want anyone preferably within a 200 foot radius

3. When people see the Humira commercial with a woman wandering around you are the first to explain what Crohn’s is

4. You are more knowledgeable than 99% of the population on what Crohn’s is (you might know even more than your own doctor about the disease)

5. When you take Prednisone you feel like Bradley Cooper in the movie “Limitless” and enjoy eating until you start putting on weight

6.  You worry if and when surgery will happen to you

7.  When someone ask you what having Crohn’s is like you want to tell them “Well it is like having the stomach flu every day of your life”

8. You wonder if and when a cure will be found

9. Sometimes you enjoy bowel movements because you feel like you just flushed out a devil inside your stomach

10. Every day you think of what your life would have been like if you were never diagnosed with Crohn’s

Crohn’s in Penis and Orgasms?

Since I was diagnosed with Crohn’s I have noticed some discomfort in my perianal area (for me penis and near the anus). Sometimes there is testicle discomfort but it randomly comes and goes (I believe Crohn's related). However, when I look up what perianal for Crohn’s actually is it is very different from what I feel. As Crohn’s patients know Crohn’s can affect you anywhere from your mouth to anus. I have a feeling I am being affected on the latter. What is strange is that when I have orgasms now there is a little bit of a twist (tingle) that wasn’t there before.  I just read about women who had Crohn’s and this problem but haven’t see any males right about it. Feel free to write in the comments section and tell me if you have had a similar experience. 

Sleep and Crohn’s?

This recent study came out and discussed the affects of sleep on the immune system. The main point of the article is that sleep can affect the immune system like physical stress. Since Crohn’s is does deal with the immune system it would be interesting to see how sleep affects Crohn’s patients or if Crohn’s patients have a history of sleep problems. I know for myself a few months before I was diagnosed with Crohn’s I was taking sleeping pills every so often because I had trouble falling asleep. Also I was taking Nyquil when I got stuffed up. Maybe this contributed to me getting Crohn’s I am not sure. I do know that when get enough sleep I feel a lot better and my pain seems to be a little less. Although, the exact same thing could be said for people who don’t have Crohn’s. An interesting study might be to see how sleep affect TNF levels.