OBJECTIVES: Advanced ileocecal Crohn’s disease (ICD) is characterized by strictures, inflammation in the enteric nervous system (myenteric plexitis), and a high frequency of NOD2 mutations. Recent findings implicate a role of NOD2 and another CD susceptibility gene, ATG16L1, in the host response against single-stranded RNA (ssRNA) viruses. However, the role of viruses in CD is unknown. We hypothesized that human enterovirus species B (HEV-B), which are ssRNA viruses with dual tropism both for the intestinal epithelium and the nervous system, could play a role in ICD.
METHODS: We used immunohistochemistry and in situ hybridization to study the general presence of HEV-B and the presence of the two HEV-B subspecies, Coxsackie B virus (CBV) and Echovirus, in ileocecal resections from 9 children with advanced, stricturing ICD and 6 patients with volvulus, and in intestinal biopsies from 15 CD patients at the time of diagnosis.
RESULTS: All patients with ICD had disease-associated polymorphisms in NOD2 or ATG16L1. Positive staining for HEV-B was detected both in the mucosa and in myenteric nerve ganglia in all ICD patients, but in none of the volvulus patients. Expression of the cellular receptor for CBV, CAR, was detected in nerve cell ganglia.
CONCLUSIONS: The common presence of HEV-B in the mucosa and enteric nervous system of ICD patients in this small cohort is a novel finding that warrants further investigation to analyze whether HEV-B has a role in disease onset or progress. The presence of CAR in myenteric nerve cell ganglia provides a possible route of entry for CBV into the enteric nervous system.
Although the primary endpoint of the study (induction of remission) was not achieved, a short course (8 week) of THC-rich cannabis produced significant clinical, steroid-free benefits to 11 patients with active CD, compared to placebo, without side effects.
Of the TNF-α antagonists, infliximab-associated liver injury has been the best documented, most likely because of its earlier approval and more wide-spread clinical use. Etanercept and adalimumab have also been linked to drug-induced liver injury. So far, there are no published cases found to be linked to natalizumab, golimumab or certolizumab.
JOHN HAMILTON, 59, was so ill he could only eat ice lollies and so weak he was almost bedridden before receiving a small intestine and abdominal wall double transplant.
RHB-104 is a proprietary antibiotics drug combination for treatment of Crohn’s disease.
RHB-104 will be indicated for treatment of Crohn’s patients. There is currently no other effective, long-term cure for Crohn’s disease. Current standard of care includes 5-ASA agents, corticosteroids, immunomodulating drugs (e.g. Methotrexate) and anti-TNFα (e.g. Remicade, Centocor (J&J)). However, standard care leaves an unmet medical need for a long lasting treatment with low side-effects. RHB-104 holds promise for providing long term remission with reduced side-effects allowing affected patients to lead normal lives. The combination therapy demonstrated promising results in phase II and phase IIIa trials in Australia.
RedHill is expected to commence a Phase III clinical trial in North America and Israel with RHB-104, planned to begin in the first half of 2013 and is also planning a European Phase III clinical trial.
Lactoferrin is an antibacterial chemical in the white blood cells that emits something equivalent to tear gas when in attacking mode.
Smarr’s lab results showed that his levels of lactoferrin were 124 times the upper limit. He read in medical studies that this chemical has been shown to differentiate between irritable bowel syndrome and inflammatory bowel disease, which includes Crohn’s disease.
Dr. Susan Blum runs the Blum Center for Health in Westchester County but for those who can’t go, there’s The Immune System Recovery Plan which covers ailments including Crohn’s Disease and Lupus.
In support of improving IBD diagnosis and treatment, LabCorp has launched an expanded IBD testing profile that helps to identify IBD patients and differentiate between ulcerative colitis and Crohn’s disease. The IBD Expanded Profile includes ulcerative colitis and Crohn’s disease-specific antibody markers that improve diagnostic sensitivity and provide valuable prognostic information regarding the severity of disease. For patients diagnosed with IBD, LabCorp’s TPMT Enzyme Activity assay can be utilized prior to thiopurine drug treatment to assess dosing levels and potential adverse drug reaction. Once a patient has started thiopurine treatment, physicians can use the thiopurine Metabolites test to help optimize ongoing dosing to reach and maintain therapeutic goals and avoid possible drug toxicity. LabCorp also offers testing for patients treated with new biological drugs like infliximab that allow physicians to monitor drug concentration levels and assess the impact of anti-infliximab antibody levels on drug efficacy.