Best of 2013
New Approach to Curing Crohn's
Seattle Children's researchers are using fecal transplant to find cures for inflammatory bowel disease in children.
Seattle Children’s led the first FDA-approved study of fecal microbiota transplant (FMT) in children with inflammatory bowel disease (IBD), with promising results. The treatment appeared to improve clinical symptoms and lower inflammatory markers for seven of 10 patients with Crohn’s disease.
The research could change the way Crohn’s disease is treated and help unravel the mystery of what causes it.
The research team, led by gastroenterologist Dr. David Suskind, is awaiting FDA approval for a second study in a larger group of patients with Crohn’s disease.
“Instead of doing what we do now – treat the immune system reaction with powerful anti-inflammatory medications – we could potentially alter the bacteria in a patient’s digestive tract to treat whatever the primary culprit is that causes IBD,” says Suskind, an investigator at the Seattle Children's Research Institute.
Efficacy for Crohn’s, not colitis
FMT isn’t new; it’s a tried-and-true, low-risk treatment for recurrent bouts of Clostridium difficile infection (C. diff), a debilitating intestinal bacteria. In fact, Suskind was treating a patient for C. diff when he stumbled across its potential role in IBD – not only did the patient’s C. diff infection improve, so did her ulcerative colitis symptoms and inflammatory markers.
Was it more than coincidence? To find out, Suskind designed a study that Children’s supported through its Academic Enrichment Fund, a program that awards research funding to clinicians who primarily focus on patient care and education.
The study included 10 patients with Crohn’s disease and 10 with ulcerative colitis, all of whom were experiencing flare-ups of their symptoms. Each patient received a single treatment of stool (donated by their parent) mixed with saline, via a nasogastric tube.
While patients with ulcerative colitis did not improve significantly, the majority of those with Crohn’s did – and some have continued to feel better more than six months after treatment.
Dr. Sam Miller, professor of Microbiology, Genome Sciences and Medicine at the University of Washington School of Medicine, is completing a before-and-after analysis of each participant’s microbiome to pinpoint the bacterial changes and determine if they correlate with clinical improvement.
“Each individual can house more than 1,000 of the 40,000-plus species of bacteria that can potentially live in the digestive system,” says Suskind. “Our technology allows us to analyze them and narrow in on the culprits that trigger the immune system and cause IBD.”
The next study
For the next stage of research, Suskind has secured private funding for a double-blind, placebo-controlled trial of FMT in 32 patients with Crohn’s disease. Like the initial study, this one will also include Miller’s before-and-after analyses of the microbiome to look for bacterial changes.
Suskind expects to start enrolling patients in the spring of 2014.
“This is the golden age of research for inflammatory bowel disease,” says Suskind. “It’s an exciting time to be working in this field, because we’re so close to finding answers to some of our most important questions – and it’s possible that cures are right around the corner.”
"We could potentially alter the microbiome to treat whatever the primary culprit is that causes IBD." - Dr. David Suskind