IBD: a new hope for treatment linked to the microbiota

What is IBD?

The physiopathology is characterized by an inflammation of the digestive wall and a deregulation of the immune system. This results in abdominal and/or rectal pain, abundant diarrhea, nausea, vomiting, fatigue, rectal bleeding, etc.

The disease is usually diagnosed between 20-30 years of age. The diagnosis requires a wide range of investigations: clinical, biological (CRP, calprotectin, etc.), endoscopic, radiological and histological (to confirm the occurrence of intestinal, rectal or colonic lesions). The symptoms of IBD may be similar to other digestive diseases such as celiac disease or an intestinal infection, which complicates the diagnosis.

What are the treatments and impacts on quality of life?

After the diagnosis, the challenge is to learn to live with the disease. A chronic disease such as IBD is not only limited to the organic symptoms of the disease (abdominal pain, diarrhea, nausea) but also to the systemic (fatigue, etc.), psychological and social impact.

Unfortunately, to date, treatments aim to reduce inflammation and immune dysregulation with corticosteroids, immunosuppressants (Ciclosporin, …), aminosalicylates and biotherapies (Anti-TNF, Vedolizumab, …), but do not allow for healing. Despite these treatments, IBD still has a strong impact on the quality of life of patients.

A French survey conducted in 2008 on 2424 patients, published by the National IBD Observatory, revealed :

• An impact on professional activity: about half of the patients had benefited from at least one work stoppage per year and the duration was on average 2 months. The repercussion on professional activity can take other forms with an adjustment of schedules, choice of professional orientation, renunciation of the desired profession, change of profession, …
• An impact on daily life: mainly fatigue, stress, etc.
• An impact on social life: isolation, limitation of leisure activities, etc.

What devices exist to make life easier for IBD patients?

Several health solutions have been developed to strengthen the support, information and management as well as to limit the impact of the disease for the patient.

MICI connect

An informative, support and exchange platform to better live with an IBD disease. The site is intended for patients and also for health professionals.

The site is composed of several modules:

• An informative area: information materials to better understand the disease
• Health questionnaires: to evaluate quality of life and monitor the evolution of the disease
• An online appointment area: to discuss with an expert patient or a specialized practitioner to reinforce the support of the person suffering from IBD
• A health booklet: to record health documents online (prescriptions, etc.)
• An area for discussion: between IBD patients, but also expert patients and health professionals
• An area dedicated to research: questionnaire, survey, research studies

The National IBD Observatory

The National IBD Observatory is an initiative of the François Aupetit Association (AFA) to monitor the number of patients, find research opportunities, improve the quality of life of patients, establish risk factors, evaluate health actions, and carry the voice of patients.

EASY IBD

This is a software program that allows the creation of a national multicenter observatory on the management of IBD in the private sector. The tool is dedicated to health professionals to register the management of their patients, which allows a descriptive analysis of practices.

The MaRDI centers

The MaRDi (Rare Digestive Diseases) centers are accredited centers for the management of rare digestive diseases and IBD. These centers bring together a network of medical and social professionals, and also patient associations, with the aim of improving diagnosis and care for patients, optimizing the treatment process, organizing therapeutic education and promoting research. With about thirty centers throughout France, the network is connected to partner laboratories (INSERM in particular) and learned societies (GFHGNP, etc.) to pool knowledge and boost research.

What future for the development of new treatments: the hope of the intestinal microbiota?

Current therapies target a mainly anti-inflammatory action. However, their action leads to short and long term side effects (nausea, allergic reactions, pancreatitis, …). The microbiota is a field to which many researchers have turned to find new therapeutic opportunities. In case of IBD, the composition of living microorganisms in the microbiota may be altered. Research on the microbiota enables to initiate the following approaches:

Fecal transplantation

Fecal microbiota transplantation consists of introducing stool from a healthy person into a patient’s digestive tract to rebuild the patient’s microbiota and to fight against pathogenic bacteria. This treatment is currently limited to recurrent Clostridium difficile infections. The success in restoring a balanced microbiota has led researchers to turn to this treatment for IBD. However, the presumed role of the intestinal microbiota in IBD is only one factor among others, contrary to C. difficile infection which is almost exclusively linked to an alteration of the intestinal microbiota. Fecal transplantation remains an interesting field to be optimized and synchronized in a global management.

Nanoparticle probiotics

Probiotics are composed of living microorganisms that are beneficial to the health of the host. They have been used for several years in the form of food supplements to rebalance microbiota. Their effectiveness depends on several factors, including their composition in bacterial strains, and some strains have shown difficulties of absorption. To address this issue, researchers have encapsulated the Bacillus amyloliquefaciens (BA) strain in a nanoparticle to treat colitis in rats. This mode of action improved the stability of the strain and allowed for a longer mode of action in the gastrointestinal tract, resulting in increased efficacy.

Synthetic glycans

Synthetic glycans are synthetic polysaccharide compounds that approximate the chemical characteristics of dietary fiber. These synthetic compounds could play a role in modulating the composition of the microbiota, and thus promote certain bacteria, particularly anti-inflammatory bacteria, to treat IBD, as shown in studies in rats.

These latest promising health solutions still require years of research, on animals and humans, to optimize their formulation and prove their effectiveness. They will probably offer more choices in the IBD therapeutic arsenal.

Beyond these approaches around the gut microbiota, research continues to test new hypotheses to prevent inflammation such as vagal neurostimulation (electrical stimulation of the vagus nerve to induce anti-inflammatory effects), which showed beneficial results in a clinical study initiated by the Grenoble University Hospital in 2012. In addition, new alternative techniques are also being developed to deal with pain on a daily basis. This is notably the case of hypnosis, which has been the subject of clinical trials showing a reduction in abdominal pain in IBD.

IBD is a risk factor for colorectal and intestinal cancer. Supporting research to prevent the appearance of lesions is therefore essential to reduce the risk of developing cancer and improve the quality of life of patients. Getting knowledge of the microbiota and its functioning is a source of hope for the patients concerned. Alcimed, is listening to you to support your projects around these subjects.

About the author,

Maureen, Consultant in Alcimed’s Life Sciences team in France