Microbiome Breakthrough: New Crohn's Treatment Unveiled

[J100]

I came across this article. Research done by

https://www.miragenews.com/microbiome-breakthrough-new-crohns-treatment-1406399/​

@kiny , @my little penguin , @Scipio -your thoughts and comments

 

[my little penguin]

My two cents
You need to wait and see
Most mice models for various treatments don’t have large success rates in humans for Crohn’s disease
Fecal transplant doesn’t have high success rates at all for crohns
Een does have success in certain circumstances especially little kids since parents ensure compliance .
Een has its own risks though .
It would be nice if it were true but
Early stages
Needs more time /experiments especially on the fecal transplant side .
Een is a good treatment plan in the short term for kids and adults until you get a maintenance plan that works for you

 

[Scipio]

I agree with MLP. The mouse models for human IBD are pretty lousy. Something that works well in mice may or may not have much to say about human disease.

What they've got here is perhaps enough data to justify a small human safety trial. If it looks safe for humans then move on to an efficacy trial, but I'm not getting excited about any new therapy until I see the human clinical trial data.

 

[J100]

@my little penguin & @Scipio - I agree that models which work in mice may not work at all in humans. However, if this is successful then it will be great though it may take years for any such research to be fruitful.

 

[Michael Harrop]

The "mice" part is largely irrelevant. I would not call this a breakthrough or "new" treatment.

The liquid diet has existed for a long time. The microbiome and FMT are not exactly "new" but it's definitely surprising how many people are ignorant about it.

I don't find anything promising in this article. There have been plenty of FMT clinical trials. The problem is that people with "good enough" gut microbiomes to be highly effective stool donors are extremely rare. The people running the FMT clinical trials put little to no effort into finding such donors, so the trials they run are largely useless, and even harmful.

As a patient who's been following this area of research, and has been very frustrated by this, I've been trying to find such donors myself. The FDA stopped me and I've been staying in my car in DC since November, visiting the congressional offices most days, trying to get someone in the federal government to do something.

If you want to learn about this and help, read this.

 

[J100]

The "mice" part is largely irrelevant. I would not call this a breakthrough or "new" treatment.

The liquid diet has existed for a long time. The microbiome and FMT are not exactly "new" but it's definitely surprising how many people are ignorant about it.

I don't find anything promising in this article. There have been plenty of FMT clinical trials. The problem is that people with "good enough" gut microbiomes to be highly effective stool donors are extremely rare. The people running the FMT clinical trials put little to no effort into finding such donors, so the trials they run are largely useless, and even harmful.

As a patient who's been following this area of research, and has been very frustrated by this, I've been trying to find such donors myself. The FDA stopped me and I've been staying in my car in DC since November, visiting the congressional offices most days, trying to get someone in the federal government to do something.

If you want to learn about this and help, read this.

@Michael Harrop - A couple of years ago, I used to think that FMT could be a possible solution but after discussing it with a few people in in this forum, I am of the view that once the epithelial wall integrity is breached, FMT will not heal it or cause remission of a flare up. But that is just my opinion and I am not a doctor. I wish you all the best in your journey.

 

[kiny]

A healthy intestine is in a chronic state of low grade inflammation. The epithelial cells and the lamina propria are full of immune cells, abnormally high number of immune cells compared to other tissue in the body, indicating the intestine is a highly stressed organ.

Millions of naive immune cells originate in the thymus, travel through the bloodstream, end up in peyer's patches in the ileum and intestinal tissue. Many more are recruited when dendritic cells come into contact with antigen. That antigen comes from bacteria and the fecal stream.

These armies of immune cells are all triggered by bacteria or food antigen. The fecal stream is full of bacteria and food antigen. Using FMT to try to treat crohn's disease is like taking gasoline and throwing it on a fire.

That's why these FMT studies had crohn's disease studies where calpro jumped and they needed immediate escalation of anti-inflammatories. FMT is no longer pursued for crohn's disease, a good thing, because they would have eventually killed patients due to bacteremia. People with crohn's disease have deep transmural inflammation, granuloma where immune cells try to wall off fecal content. The last thing you want to do is expose these people to a FMT. It's dangerous, and it was highly predictable that this would not work and would cause adverse effects.

FMT does not work and harms patients. Doctors still doing this to patients need to be in jail, it is malpractice.

"21 and 13 patients were randomized to FMT and placebo groups, respectively. The trial terminated early due to futility. At week 8, 0% (0/15) of patients in the FMT group versus 8.3% (1/11) in the placebo group reached the primary end point of combined clinical and endoscopic remission as per protocol analysis."
https://journals.lww.com/ajg/fullte...ults_from_a_multicenter,_randomized.1438.aspx

"10 CD patients underwent FMT and were evaluated for clinical response and microbiomeprofile at one month post-FMT. There was no significant improvement in objective measures of inflammation such as fecal calprotectin and SES CD score. Single-dose FMT in this cohort of CD patients showed modest effect and potential for harm."
https://onlinelibrary.wiley.com/doi/10.1177/2050640619845986