Ulcerative colitis: Fresh approaches to taming inflammation

Ulcerative colitis: Fresh approaches to taming inflammation


Ulcerative colitis is one of the most common
forms of inflammatory bowel disease and is characterised by inflammation
of the colon and the rectum. The walls of the colon — also known
as the mucosa — become inflamed and no longer provide an effective
barrier between the inner cavity and the surrounding connective tissue, allowing
gut microbes to cross the epithelial layer. This causes inflammation of the mucosa and
leads to a raft of unpleasant symptoms such as abdominal pain, diarrhea,
fatigue and rectal bleeding. There are several commonly used anti-inflammatory
and immunosuppressive drugs, but they come with side effects and
aren’t long-lasting for many patients. Currently, 15% of people with
ulcerative colitis will require surgery to remove some or all of the
colon within 20 years of diagnosis. Luckily, new insights into
the immunology of this condition are helping scientists develop
new effective treatments. One new class of treatments is aimed at
preventing the inflammation in the first place, by bolstering the physical
integrity of the colon’s epithelium. This keeps the immune-triggering bugs
confined to the interior of the colon. Some of these treatments work by
exploiting a human protein called IL-22 which helps strengthen the epithelial layer. One new drug in development targets the
receptor for IL-22 on the epithelium itself, activating it and thereby initiating healing
of epithelial cells and the mucus layer. This drug is currently in phase two trials. Researchers are also trying to use a
plant product called indigo naturalis which encourages immune cells in the area to
release IL-22, again healing the epithelial barrier. There are also new therapies emerging that prevent
immune cells from entering the affected area. where they might become activated
to invoke an inflammatory response. One way to do this is to inhibit proteins called
integrins which live on the surface of T cells. A new antibody drug that works this way stops
T cells from getting across the blood vessel wall into the mucosa and also blocks
their binding to the epithelium. This drug appears to effectively
reduce pain and inflammation. Another group of drugs uses
a totally different approach, targeting key inflammatory signals
between different immune cells. For example, one new drug tampers with
the cellular machinery inside T cells so that they no longer respond
to messages from macrophages. In a pivotal phase three trial, this drug
induced remission in over 40% of patients and has now been approved for the
treatment of active ulcerative colitis. A final approach to treating this disease is to
restore the healthy balance of the gut microbiome. One way of doing this is to
use probiotic bacteria streams. Adding these commensal bacteria
back into the intestine’s gut community has been shown to quell inflammation
and restore normal intestinal function. One particular probiotic, known as E. coli nissle,
has been shown to keep symptoms at bay just as effectively as widely
used anti-inflammatory drugs. Fecal transplantation from healthy
donors is also being experimented with, although results to date are conflicting. At least one recent study on multi-donor stool transplantation has shown promising results however, eliminating symptoms in a quarter of patients. As new approaches to tackling
this disease come onto the market, the hope is that more patients will be free of symptoms
for longer and won’t go on to need aggressive surgery.

14 Comments

  1. IL-22 Treatment & E. Coli Nissle look promising whereas Immunosupressors acting on Neutrophils could have devastating effect on overall Innate Immune System

  2. Brilliant that medicine has many classes of drugs to 'tame' the inflammation- how about working on what causes the inflammation in the first place? A patient I had 30 years ago lay on the bed while I packed gauze around his 30cm surgery wound that was not healing. He admitted that he thought the piece of colon he had removed was due to drinking two pots of coffee/day along with the odd Coke. He ate relatively no fresh fruit and veg. No doubt this had an impact on his inability to heal requiring me to pack his open gut. The nutritionist had been to visit and then his lunch tray arrived with a white bread sandwich and a cup of coffee!

  3. I like this 'nature' approach to animate science; it makes the cold nature of published papers and figures more amiable to others oriented with the medical field

  4. What this video fails to mention is one of the main causes of inflammation that not only weakens the integrity of the mucosa in the gut but also that of the Blood Brain Barrier which then facilitates toxins reaching the brain. EMF pollution has proven mechanisms that do this. CMO technology is proven and published in peer-reviewed journals to mitigate these adverse effects. See https://comosystems.co.uk/ for details

  5. There are lot of ayurvedic classical drug formulation for this condition;e.g. Bilbaadi choorna,kutaz ghan vati,panchamrit parpati etc

  6. Sad But no mention of helminthic which is where all those patients who fail on the others end up. Even lots of FMT people too… But there are some great synergies to helminthic and FMT…. Its idiotic the lack of awareness about helminthic that has over 75% remission rates.

  7. Overeating is the major issue for gut inflammation, apart from other things. 🍴 🎂
    One can treat symptoms for ever, OR stop overeating by having a smaller plate in the house. Also, the knowledge about the personal food allergies is powerful for personal health !

  8. Microbes = Mexicans
    Epithelial cells = the wall
    1L22 = builders
    White blood cells = Americans

    W E N E E D T O B U I L D A W A L L !

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