tag:theconversation.com,2011:/uk/topics/crohns-disease-6497/articlesCrohn's disease – The Conversation2024-03-15T17:34:41Ztag:theconversation.com,2011:article/2131852024-03-15T17:34:41Z2024-03-15T17:34:41ZGut microbiome: meet Roseburia intestinalis — the energy-producing bug that helps us fight diseases<figure><img src="https://images.theconversation.com/files/582161/original/file-20240315-18-p5czjg.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4872%2C3223&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">_R intestinalis_ makes butyrate from polysaccharides, which are found in starchy foods such as potatoes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-eating-fish-potatoes-572976808">Photo Oz/ Shutterstock</a></span></figcaption></figure><p>The hundreds of species of microorganisms that comprise the microbiome all have different, unique roles. </p>
<p>One of the important functions that takes place in the gut is the production of short-chain fatty acids. These molecules are derived from the fermentation of <a href="https://pubmed.ncbi.nlm.nih.gov/2902962/">polysaccharides</a> (a type of carbohydrate) which are primarily found in starchy foods. These short-chain fatty acids are then used in a range of processes – including providing cells with the energy they need to grow and multiply and enabling communication between the gut and the brain.</p>
<p>The gut’s microbes mainly make three short-chain fatty acids: acetate, propionate and butyrate. Together, these provide around <a href="https://microbialcellfactories.biomedcentral.com/articles/10.1186/s12934-017-0691-z">60% of all energy used by the intestinal cells</a> – and about 10% of our body’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735932/">overall calorie requirements</a>. </p>
<p>Arguably, the most important of these short-chain fatty acids is butyrate, which has been widely studied due to its apparent <a href="https://www.sciencedirect.com/science/article/pii/S216183132200833X">links to health and disease</a>. </p>
<p>Butyrate is the primary source of energy used to create and maintain the mucus membrane that lines our digestive tract. This lining is vital for healthy gut function, protecting the body from infection and absorbing nutrients from the foods we eat. </p>
<p>One of the primary producers of butyrate in the gut is the bacterium <em>Roseburia intestinalis</em>.</p>
<h2>Energy production</h2>
<p><em>R intestinalis</em> lives in close contact with the mucus membrane of our gut cells and makes up just over <a href="https://journals.asm.org/doi/10.1128/aem.69.7.4320-4324.2003">2% of the entire population</a> of the human gut microbiome. It creates butyrate from the polysaccharides we eat using a <a href="https://academic.oup.com/gbe/article/6/3/703/580436">special type of enzyme</a>. While it isn’t the only bacterium in the gut that produces butyrate, <em>R intestinalis</em> is one of its <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">most abundant producers</a>.</p>
<p><em>R intestinalis</em> has been linked to <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">many health benefits</a>, such as preventing inflammation and restoring good bacterial balance in the microbiome. </p>
<p>This bacterium also seems to regulate some of the communication that happens between the <a href="https://journals.sagepub.com/doi/full/10.1177/17562848211004469">gut and brain</a> – and may even play a role in <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2021.757718/full">protecting against some diseases</a>, such as Crohn’s, ulcerative colitis and both type 1 and type 2 diabetes. </p>
<figure class="align-center ">
<img alt="A digital rendering of the human brain." src="https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582167/original/file-20240315-24-crh3oc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">This bacterium helps facilitate communication between the gut and the brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/human-brain-floating-on-blue-background-260226050">Fer Gregory/ Shutterstock</a></span>
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<p>These health benefits are probably thanks to the fact that the butyrate <em>R intestinalis</em> produces provides nutrients and energy to other bacterial species who have more specialised jobs in the gut. Butyrate also helps regulate many aspects of our <a href="https://www.tandfonline.com/doi/full/10.2147/JIR.S300989">immune system</a>. It does this through promoting or suppressing the production of key immune cells.</p>
<p>Much of these discoveries of <em>R intestinalis’s</em> benefits are very recent and more research will be needed to better confirm what specific roles this bacterium plays in the gut, and how exactly it enhances our own fight against disease. </p>
<p>Butyrate production may also be more complex than it appears, with studies finding a link between low levels of butyrate production <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12068">and obesity</a>.</p>
<p>But given its key role in promoting a healthy gut – alongside its wider effects on the immune system and body – it’s no wonder <em>R intestinalis</em> is starting to be considered as a potential probiotic. This would mean we could see it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9493362/">added to supplements</a> in order to promote a healthier microbiome in the future.</p>
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/213185/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor Meehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>R intestinalis is one of the gut’s primary producers of butyrate – a source of energy for many of the gut’s cells.Conor Meehan, Associate Professor of Microbial Bioinformatics, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097162023-07-25T11:54:58Z2023-07-25T11:54:58ZCrohn’s disease: bacteria in the mouth may be a cause – here’s why<figure><img src="https://images.theconversation.com/files/539046/original/file-20230724-23-agvl7j.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C6779%2C5100&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We swallow millions of bacteria each day in our saliva.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacterias-viruses-around-tooth-dental-hygiene-582947515">Maxx-Studio/ Shutterstock</a></span></figcaption></figure><p>Crohn’s disease affects <a href="https://doi.org/10.1038/nrgastro.2015.150">four million people</a> worldwide. The condition causes debilitating symptoms such as chronic fatigue, diarrhoea, abdominal pain, weight loss and malnutrition. Once symptoms develop, Crohn’s is a lifelong condition – and while there are ways to manage symptoms during flare-ups, there’s currently no cure.</p>
<p>The exact causes of Crohn’s disease are unknown and are probably due to a number of complex and <a href="https://www.nhs.uk/conditions/crohns-disease/">overlapping factors</a> – such as genetics, environmental cues (such as smoking) and an immune system that’s overactive in the gut. Research has also shown that the gut microbiome plays a crucial role in the disease.</p>
<p>The gut microbiome is a collection of trillions of bacteria, viruses and fungi. These microbes are present from birth and play a crucial role in ensuring the gut cells and our intestines function as they should. The bacteria in our gut also help our immune cells function as they should, ultimately ensuring it is effective.</p>
<p>Many studies show that people with Crohn’s disease have a less diverse community of <a href="https://doi.org/10.1038/nmicrobiol.2017.4">gut bacteria</a>. They also have higher levels of certain types of bacteria that can trigger gut inflammation. </p>
<p>But it isn’t only the gut’s bacteria that show signs of dysfunction in people with Crohn’s disease. Rather unexpectedly, research also shows that the <a href="https://doi.org/10.1038/s41575-021-00488-4">bacteria in the mouth</a> might also be important in this inflammatory condition.</p>
<h2>Mouth microbiome</h2>
<p>When we’re in the womb, our gut is sterile. But our gut microbiome begins to develop the moment we’re born – first after coming in contact with vaginal bacteria during birth, then from other maternal sources such as breast milk and skin, as well as our environment.</p>
<p>By the time we’re adults our gut becomes a thriving community of <a href="https://doi.org/10.1371/journal.pbio.1002533">trillions of bacteria</a> which, by some estimates, <a href="https://doi.org/10.1093/ajcn/25.12.1292">outnumber our cells by 10:1</a>.</p>
<p>Most of the bacteria that make it to our guts had to travel through our mouths first. As such, our mouth contains the second highest number of bacteria after the gut. And, we swallow these millions of bacteria daily <a href="https://doi.org/10.1067/mpr.2001.113778">in our saliva</a>.</p>
<p>The oral microbiome is complex. Each part of our mouth – whether it’s the tongue, cheek or our saliva – <a href="https://doi.org/10.1038/nature11234">is composed of different microbes</a> depending on factors such as pH level and oxygen levels. These communities of microbes can then form <a href="https://doi.org/10.1038/s41579-018-0089-x">complex structures</a> called biofilms, where bacteria organise themselves on mouth surfaces (dental plaque is one example). The bacteria then interact with each other and our immune cells to create a harmonious state of health.</p>
<p>There are a couple of reasons why researchers think the oral microbiome might play a role in Crohn’s disease. </p>
<p>First, studies indicate that people with Crohn’s disease have <a href="https://doi.org/10.1093/dnares/dst037">different bacteria in their mouths</a> compared to those without the condition. This could suggest that certain species of bacteria present in the mouth may play a role in Crohn’s disease.</p>
<p>Second, a few species of bacteria commonly found in higher abundances in the intestine of people with Crohn’s disease compared to healthy people are also <a href="https://doi.org/10.1016/j.chom.2014.02.005">present in the mouth</a>. This is perhaps unsurprising, given the entry route of bacteria into the lower gut is generally via the mouth. In fact, it’s not uncommon for people with Crohn’s disease to develop <a href="https://doi.org/10.1053/j.gastro.2021.07.042">ulcers</a> in the mouth, alongside those commonly seen in the gut.</p>
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<img alt="A digital drawing of the gut microbiome and the many bacteria in it." src="https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=606&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=606&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539047/original/file-20230724-17-f0q8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=606&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The bacteria in our gut travelled through our mouth first.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/gut-bacteria-flora-microbiome-inside-small-1649015530">Anatomy Image/ Shutterstock</a></span>
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<p>Research in humans also suggests that one oral bacterium in particular, called <em>Veillonella parvula</em>, is abundant in the guts of people with Crohn’s disease. This bacterium is associated with diseases such as periodontitis and even meningitis. It’s typically found in the oral microbiome, but one notable study has shown it has developed a <a href="https://doi.org/10.1038/s41564-022-01224-7">way to live</a> in the lower gut.</p>
<p>If other bacterial culprits of Crohn’s found in the gut are also found in the mouth, this might allow researchers to develop better tests that only need a saliva sample to diagnose the disease. This would be much easier than needing patients to provide a stool or gut tissue sample.</p>
<p>Researchers will also need to investigate whether the oral microbiome may cause Crohn’s. Research <a href="https://doi.org/10.1016/j.cell.2020.05.048">in mice suggests</a> that inflammation (which happens when the immune system is triggered by a pathogen) makes it easier for certain types of bacteria to grow – leading to even greater inflammation and an over-activation of immune cells. If the same is true of the oral bacteria linked to Crohn’s disease, it could suggest that bacterial overgrowth and inflammation in the mouth is a possible root cause of Crohn’s.</p>
<h2>Other diseases</h2>
<p>Crohn’s is not the only disease in which certain mouth bacteria are implicated. </p>
<p>For instance, researchers have shown that two toxic chemicals produced by the oral bacteria <em>Porphyromonas gingivalis</em> (which is involved in gum disease) were found in more than 96% of participants in brain regions <a href="https://www.science.org/doi/10.1126/sciadv.aau3333">associated with memory</a>. Significantly, these toxic chemicals feed on human cells.</p>
<p>In <a href="https://doi.org/10.1038/s41467-020-16967-2">breast cancer</a>, the oral bacteria <em>Fusobacterium nucleatum</em> has been linked with accelerated tumour growth and the spread of cancer cells. <a href="https://www.science.org/doi/10.1126/science.aal5240">Many studies</a> have also shown that the same bacterium is often found in colorectal cancer tissues. </p>
<p>Additionally, there has been a long-held idea that oral bacteria may have a substantial impact on <a href="https://doi.org/10.3389/fimmu.2022.1010368">cardiovascular disease</a>, where microbes may leak into the bloodstream and take residence in heart plaques, leading to inflammation – and thus a higher likelihood of rupture or blood vessel blockage.</p>
<p>Although the oral microbiome has been associated with the development and progression of Crohn’s disease, research has not fully worked out the exact way by which bacteria may move from the mouth to parts of the gut. And although there’s plenty of data from mouse studies, more research showing this link in humans is needed.</p>
<p>Better understanding how the oral bacteria are involved in Crohn’s disease – and which species may be implicated – will help develop better diagnostics and treatments, not only for Crohn’s disease but many other conditions as well.</p><img src="https://counter.theconversation.com/content/209716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gwo-tzer Ho receives funding from.
Medical Research Council
Chief Scientist Office, Scotland
Helmsley Charitable Trust
Jon Moulton Foundation
Crohn's and Colitis UK
European Research Council</span></em></p><p class="fine-print"><em><span>Robert Whelan receives funding from the Medical Research Council. </span></em></p>The oral microbiome has also been linked to other diseases, such as breast cancer and Alzheimer’s.Gwo-tzer Ho, Reader and Honorary Consultant Gastroenterologist, The University of EdinburghRobert Whelan, PhD Candidate, Centre for Inflammation Research, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738792022-02-14T13:22:23Z2022-02-14T13:22:23ZWhy do people get diarrhea?<figure><img src="https://images.theconversation.com/files/442542/original/file-20220125-23-5eakbl.jpg?ixlib=rb-1.1.0&rect=0%2C519%2C5058%2C2800&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No matter its cause, diarrhea is uncomfortable.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-holding-toilet-tissue-roll-in-bathroom-royalty-free-image/1249645235">Rapeepong Puttakumwong/Moment via Getty Images</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">curiouskidsus@theconversation.com</a>.</em></p>
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<blockquote>
<p><strong>Why do people get diarrhea? – A.A.A., age 10, Philadelphia</strong></p>
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<p>The digestive system breaks down everything you eat and drink to absorb nutrients and make the energy your body needs. Whatever solids can’t be broken down and used get <a href="https://www.ncbi.nlm.nih.gov/books/NBK539732/">excreted as poop</a>.</p>
<p>Poop comes in many shapes, sizes, colors and consistencies.</p>
<p><a href="https://scholar.google.com/citations?user=mHFFJtUAAAAJ&hl=en&oi=ao">Doctors like me</a> who treat people with digestive issues use what’s called the <a href="https://dx.doi.org/10.1016%2Fj.jpeds.2011.03.002">Bristol stool scale</a> to grade poop texture. It goes from Type 1 – separate hard lumps – to Type 7 – liquid with no solid pieces. The texture of the best poops, Type 4, resembles a mushy banana.</p>
<p>When your <a href="https://blog.katescarlata.com/2021/04/19/common-disorders-associated-with-diarrhea/">poop is loose and watery</a> and comes out that way at least three times a day, you have <a href="https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease">diarrhea</a>. It can be uncomfortable and inconvenient, because diarrhea tends to come out quickly and with little warning. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of the seven categories of poop, ranging from overly firm to liquid." src="https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442540/original/file-20220125-15-n9shj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Bristol stool scale puts poop into seven categories that range from the hard pellets of constipation to the splotchy liquid of diarrhea.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/bristol-stool-chart-tool-for-faeces-type-royalty-free-illustration/1250463401">VectorMine/iStock via Getty Images Plus</a></span>
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<h2>Beware of bad germs</h2>
<p>By the time food passes out of the stomach, it’s a liquid that travels through the small intestine, where nutrients are absorbed. The leftovers flow into the large intestine, where water is absorbed and poop forms.</p>
<p>When the small intestine or the large intestine can’t do its job, poop will be liquid. </p>
<p>Diarrhea usually occurs because of infections caused by many different <a href="https://www.doi.org/10.4161/gmic.1.1.11036">viruses, bacteria and parasites</a>.</p>
<p>That’s why there are <a href="https://www.epa.gov/dwreginfo/drinking-water-regulations">rules about keeping drinking water clean</a> and <a href="https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/steps-keep-food-safe">food safe</a>. It’s also why you should wash your hands before eating. </p>
<p>These germs cause diarrhea a few different ways. Often, they irritate the intestines, interfering with water absorption. Some germs cause diarrhea by <a href="https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287">releasing chemicals</a> that make the intestines release fluid, making poop even more watery. When these <a href="https://www.cdc.gov/foodsafety/foodborne-germs.html">germs come from food</a>, symptoms can include vomiting, belly pain and diarrhea.</p>
<p>To be sure, not all microbes are bad.</p>
<p>In fact, your <a href="https://doi.org/10.1038/nature11053">digestive system is filled with billions of bacteria</a> and other germs that help you digest food and protect you from bad germs. <a href="https://doi.org/10.2217/17460913.3.5.563">Taking antibiotics for an infection can cause diarrhea</a> by killing off these good bacteria along with the ones that originally made you sick. But people usually get better once they finish prescribed antibiotics and the good bacteria have a chance to recover.</p>
<p>People with diarrhea need to consume lots of liquids to stay hydrated. Water is best. Avoid <a href="https://doi.org/10.1001/archpedi.1985.02140070077039">juice</a> and <a href="https://irritablebowelsyndrome.net/food/no-soda">soda</a>, which can worsen diarrhea. Also refrain from foods that can make your digestive system work harder, like dairy products.</p>
<p><a href="https://www.childrens.com/health-wellness/how-to-treat-diarrhea-in-kids">Eating sweet potatoes, oats, beets</a> and other high-fiber foods may help firm up loose poops. Never take a medication, even if doesn’t require a prescription, for diarrhea without asking a doctor first. </p>
<h2>Many other causes</h2>
<p>There are many other causes of diarrhea.</p>
<p>Some people are born with or develop conditions over the course of their lives that can cause diarrhea.</p>
<p>A common example is <a href="http://dx.doi.org/10.1136/gutjnl-2019-318404">lactose intolerance</a>. Lactose is a sugar that is in milk that requires a <a href="https://www.britannica.com/science/lactase">special enzyme, called lactase</a>, to digest it in the small intestine. There are people who have little, or even none, of this enzyme in their small intestine. As a result, lactose travels into their large intestine without being broken down and absorbed – leaving poop very runny.</p>
<p><a href="https://doi.org/10.3389/fped.2018.00350">Celiac disease</a> can also trigger diarrhea. People with it have <a href="https://www.health.harvard.edu/healthbeat/getting-out-the-gluten">trouble digesting gluten</a>, a protein found in wheat and additional grains. For people with celiac disease, eating gluten can damage the small intestine by activating their own immune system. This damage is reversible through a gluten-free diet, but diarrhea may continue until the small intestine heals and can do its job.</p>
<p>Others have <a href="https://doi.org/10.3389/fmed.2017.00261">digestive system allergies</a>. They need to avoid eating specific foods to prevent diarrhea and other symptoms. </p>
<p>Some medications make you poop more often.</p>
<p>There are also medical conditions, like <a href="https://doi.org/10.1053/j.gastro.2021.04.063">inflammatory bowel disease</a>, such as <a href="https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304">Crohn’s disease</a> and <a href="https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326">ulcerative colitis</a>, in which the small intestine, large intestine or both become inflamed over a period of time.</p>
<p>Even your brain can play a role: Experiencing anxiety or <a href="https://www.healthline.com/health/anxiety-diarrhea">getting stressed out</a> can bring about loose poops. Some conditions, like <a href="https://doi.org/10.14309/ajg.0000000000001036">irritable bowel syndrome</a>, where the brain and the intestines do not communicate well with each other, can lead to belly pain and diarrhea, particularly amid stress. </p>
<p><a href="https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/diarrhea/art-20044799">Certain cancers</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867674/">some tumors</a> can cause diarrhea too. </p>
<p>Finally, for some people, eating spicy or fatty food or consuming artificial sweeteners or <a href="https://www.healthline.com/health/foods-that-cause-diarrhea#food-and-diarrhea">large amounts of caffeine</a> can result in diarrhea. </p>
<p>Even if you find it icky, I recommend you pay attention to your poop. If you’re having diarrhea all the time, rather than occasionally, you may need to see a doctor.</p>
<hr>
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<p class="fine-print"><em><span>Hannibal Person does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poop comes in many shapes, sizes and textures. The kind that’s too runny might be the result of wayward germs, Crohn’s disease or lactose intolerance.Hannibal Person, Assistant Professor of Gastroenterology and Hepatology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1441762020-08-21T18:09:51Z2020-08-21T18:09:51ZIBD: How a class of killer T cells goes rogue in inflammatory bowel disease<figure><img src="https://images.theconversation.com/files/353234/original/file-20200817-18-1fz4mrb.jpg?ixlib=rb-1.1.0&rect=18%2C28%2C6211%2C4119&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are currently no permanent treatments for most patients with inflammatory bowel disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-having-painful-stomach-ache-royalty-free-image/1188226212?adppopup=true">PokPak05/iStock/Getty Images Plus</a></span></figcaption></figure><p>Between <a href="https://doi.org/10.1016/S2468-1253(19)30333-4">6 and 8 million people worldwide</a> suffer from inflammatory bowel disease, a group of chronic intestinal disorders that can cause belly pain, urgent and frequent bowel movements, bloody stools and weight loss. New research suggests that a malfunctioning member of the patient’s own immune system called a killer T cell may be one of the culprits. This discovery may provide a new target for IBD medicines.</p>
<p>The two main types of IBD are <a href="http://doi.org/10.1016/S0140-6736(16)32126-2">ulcerative colitis,</a> which mainly affects the colon, and <a href="https://doi.org/10.1016/S0140-6736(16)31711-1">Crohn’s disease,</a> which can affect the entire digestive tract. Researchers currently believe that IBD is triggered when an <a href="https://www.nejm.org/doi/full/10.1056/nejmra0804647">overactive immune system attacks harmless bacteria in the intestines</a>. Although there are many treatments for IBD, <a href="https://doi.org/10.1097/mog.0000000000000536">for as many as 75% of individuals with IBD</a> there are no effective long-term treatments. This leaves many patients without good options. </p>
<p>I am a <a href="https://changlab.ucsd.edu">physician-scientist</a> conducting research in immunology and IBD and in a <a href="http://immunology.sciencemag.org/lookup/doi/10.1126/sciimmunol.abb4432">new study</a>, <a href="https://medschool.ucsd.edu/som/medicine/research/labs/chang-lab/people/Pages/default.aspx">my team</a> and our colleagues specializing in <a href="https://goldrathlab.com/">immunology</a>, <a href="https://health.ucsd.edu/specialties/gastro/areas-expertise/ibd-center/Pages/default.aspx">gastroenterology</a> and <a href="https://yeolab.github.io/">genomics</a> examined immune cells from the blood and intestines of healthy individuals and compared them with those collected from patients with ulcerative colitis to gain a better understanding of how the immune system malfunctions in IBD. There are many reasons why current treatments aren’t permanent, but one reason is that scientists don’t fully understand how the immune system is involved in IBD. It is our hope that closing the current knowledge gap about how the immune system is involved in this disorder will eventually lead to new durable treatments for IBD that target the right immune cells.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353284/original/file-20200817-16-1titleg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ulcerative colitis is a type of inflammatory bowel disease that results in chronic inflammation and damage to the large intestine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/ulcerative-colitis-royalty-free-illustration/1143632545?adppopup=true">Graphic_BKK1979/iStock via Getty Images</a></span>
</figcaption>
</figure>
<h2>Immunology 101</h2>
<p>The immune system can be divided into <a href="https://www.youtube.com/watch?v=jeN8v5I5VNA">innate and adaptive branches</a>. The innate branch is our first line of defense and acts quickly – within minutes to hours. But this system senses changes caused by microbes generally. It does not mount a targeted response against a specific pathogen, which means that some invaders can be overlooked. </p>
<p>The adaptive branch is designed to detect specific threats, but is slower and takes a couple of days to get going. T cells are a part of the adaptive immune system and can be further subdivided into <a href="https://theconversation.com/coronavirus-b-cells-and-t-cells-explained-141888">CD4⁺ and CD8⁺ T cells</a>. </p>
<p>CD4⁺ T cells are helpers that aid other immune cells by releasing soluble molecules called cytokines that can induce inflammation.</p>
<p>CD8⁺ T cells can also release cytokines, but their main function is to kill cells infected by microbial invaders. This is why CD8⁺ T cells are often referred to as serial killers. </p>
<p>After the infection is cleared and the pathogen has been destroyed, cells called memory T cells remain. These memory T cells “remember” the pathogen they’ve just encountered and if they see it again, they mount a stronger and faster response than the first time. They and their descendants can also live for a long time, even decades in the case of certain infections like <a href="https://doi.org/10.1099/0022-1317-81-5-1313">measles</a>. </p>
<p>The goal of a <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html">vaccine</a> is to provide a preview of the microbe so that the immune system can build an army of memory cells against an infectious agent, such as SARS-CoV-2, the virus that causes COVID-19. That way, <a href="https://www.theatlantic.com/health/archive/2020/08/covid-19-immunity-is-the-pandemics-central-mystery/614956/">if the virus attacks</a>, the memory T cells will spring into action and activate an immune response including the <a href="https://www.nature.com/articles/s41467-017-00843-7">production of antibodies from B cells</a>.</p>
<h2>Memory T cells that reside in organs</h2>
<p>Immunologists further subdivide <a href="https://doi.org/10.1038/ni.3031">memory T cells</a> into different classes depending on if and where they travel in the body. Circulating memory T cells are scouts that look for signs of infection by patrolling the blood, lymph nodes and spleen. </p>
<p><a href="https://doi.org/10.1016/j.coi.2018.03.017">Tissue-resident memory cells</a>, abbreviated TRM, are sentries stationed at key ports of entry into the human body – including the skin, lungs, and intestines – and act rapidly to counter an infectious threat. Intestinal TRM also function as peacekeepers and do not tend to overreact against the many harmless microbes living in the intestines.</p>
<p>In the <a href="http://immunology.sciencemag.org/lookup/doi/10.1126/sciimmunol.abb4432">new study</a>, our team analyzed blood and intestinal samples to discover that intestinal CD8⁺ TRM come in at least four different varieties, each with unique features and functions. </p>
<p>We noticed that individuals with ulcerative colitis had higher numbers and proportions of cells belonging to one of these four varieties. This particular variety, which we’ll call inflammatory TRM here, carried instructions to make very large amounts of cytokines and other protein factors that allow them to kill other cells. High levels of certain cytokines can cause inflammation and tissue damage in the body.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>It seems that in individuals with ulcerative colitis, the balance of memory cells is shifted in favor of this rogue population of inflammatory TRM that may become part of the problem by causing persistent inflammation and tissue damage.</p>
<p>We also found evidence consistent with the possibility that these inflammatory TRM might be exiting the intestinal tissue and entering the blood. Other studies in <a href="https://doi.org/10.1038/s41590-020-0607-7">mice</a> and <a href="https://doi.org/10.1126/sciimmunol.aav8995">people</a> have shown that TRM, despite being called “tissue-resident,” can leave tissues in certain circumstances. </p>
<p>By leaving the tissue and entering the blood, inflammatory TRM may be able to travel to other parts of the body and cause damage. This possibility may explain why autoimmune diseases that start in one organ, like <a href="https://doi.org/10.1007/s11894-019-0698-1">IBD</a> in the digestive tract or <a href="https://www.emjreviews.com/dermatology/article/psoriasis-beyond-the-skin/">psoriasis</a> in the skin, often affect other parts of the body.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353248/original/file-20200817-22-1e2ytlu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The balance of memory T cell subtypes changes in individuals with ulcerative colitis. Illustrations created with BioRender.com.</span>
<span class="attribution"><span class="source">John Chang</span></span>
</figcaption>
</figure>
<h2>IBD and other autoimmune diseases as a memory problem</h2>
<p>The very features that make memory T cells so desirable for vaccines – their capacity to live for such a long time and mount a stronger response when they encounter a microbial invader for the second time – may explain why autoimmune diseases are chronic and lifelong.</p>
<p>It is important to point out that none of the current drug treatments for IBD specifically target long-lived memory cells, which might be a reason why these therapies don’t work long-term in many individuals. One therapeutic approach might be to target inflammatory TRM for destruction, but this could result in side effects like suppression of the immune system and increased infections.</p>
<p>Our findings build on previous studies showing that <a href="https://doi.org/10.1053/j.gastro.2017.07.047">different TRM varieties</a>, like the <a href="https://doi.org/10.1038/s41590-018-0298-5">CD4⁺ subtype</a>, may also be involved in IBD, while other studies show that TRM play a role in autoimmune diseases affecting other organs like the <a href="https://doi.org/10.1126/scitranslmed.3010641">skin</a> and <a href="https://doi.org/10.1126/sciimmunol.aba4163">kidneys</a>.</p>
<p>The possibility that T cell memory is co-opted in IBD is exciting, but there is much that we still don’t understand about TRM. Can we selectively target inflammatory TRM for destruction? Would this be an effective treatment for IBD? Can we do so without causing major side effects? Further research will be needed to answer these important questions and to strengthen the link between TRM and IBD.</p><img src="https://counter.theconversation.com/content/144176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Chang receives research grant funding from the National Institutes of Health, the Kenneth Rainin Foundation, Takeda, and Eli Lilly.</span></em></p>Researchers discover clues to the origin of inflammatory bowel disease and a possible strategy for treatment.John Chang, Professor of Medicine, University of California, San DiegoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1432182020-08-05T14:52:10Z2020-08-05T14:52:10ZBritain’s public toilet shame: time for equal access to decent facilities for all<figure><img src="https://images.theconversation.com/files/351294/original/file-20200805-16-kzmokt.png?ixlib=rb-1.1.0&rect=4%2C2%2C1647%2C1204&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The coronavirus lockdown has amplified the problem of access to clean and safe public toilets for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/funny-wc-restroom-symbols-266672837">Shutterstock</a></span></figcaption></figure><p>As lockdown began to be relaxed in England from mid-May and people started venturing out for the first time since March, crowds flocked to parks, beaches and other beauty spots to take exercise, enjoy the outdoors and reunite with friends and family. While the taste of freedom may have been sweet, the smell often wasn’t.</p>
<p>At the time, with most public toilets still closed, <a href="https://www.lincolnshirelive.co.uk/news/local-news/long-queues-toilets-coast-people-4150562">queues around the block</a> for those that had opened and other options out of use (in shopping centres, cafes and pubs), people who were “caught short” turned to the only places on offer. <a href="https://www.theguardian.com/world/2020/jun/10/closure-of-public-toilets-causing-anxiety-distress-and-frustration-across-uk">Parks, bushes and residential streets</a> were left with smelly deposits from the general public.</p>
<p>Our work, which explores sustainable ways of managing human waste, points to an important topic for reflection post lockdown: the inadequate provision of safe, clean public toilets in the UK that are fit for purpose. </p>
<p>Most non-disabled people from affluent countries don’t often need to plan their day around toilets: it’s a case of “flush and forget”. Lack of toilet access is more frequently associated with <a href="https://blogs.lse.ac.uk/southasia/2018/08/08/book-review-where-india-goes-abandoned-toilets-stunted-development-and-the-costs-of-caste-by-diane-coffey-and-dean-spears/">low and middle-income countries</a> (LMICs), where an <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">estimated two billion people</a> still lack access to safely managed toilets, leading to deaths from diarrhoea and other sanitation-related diseases such as cholera, typhoid and polio. But inadequate toilet access has long been a feature of life for many people in the UK, too.</p>
<h2>Toilet inequity in the UK</h2>
<p>Long before the COVID-19 crisis, disabled people and those with gastrointestinal disorders such as <a href="https://www.nhs.uk/conditions/crohns-disease/">Crohn’s disease</a> and <a href="https://www.nhs.uk/conditions/ulcerative-colitis/">colitis</a>, have been forced to navigate toilets that are inaccessible, restricted and policed. This impedes their participation in everyday activities that non-disabled people take for granted.</p>
<p>The pandemic has <a href="https://inews.co.uk/news/coronavirus-covid-19-public-toilets-lockdown-lifted-crohns-asda-433318">amplified this problem</a>. Sanitation is more than just a means of disposing of bodily waste – it facilitates participation in society. Accessible toilets mean <a href="https://journals.sagepub.com/doi/10.1177/0038026119854255">citizenship, dignity and belonging</a>.</p>
<figure class="align-center ">
<img alt="Toilet signs for disabled, pregnant and elderly people" src="https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351302/original/file-20200805-475-1fjb9wz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with disabilities or special health conditions and needs have long had to deal with poor toilet provision across the country.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/signs-showing-public-toilets-special-people-1732705589">Shutterstock</a></span>
</figcaption>
</figure>
<p>Apart from <a href="https://www.accessliving.org/newsroom/blog/ableism-101/">ableism</a>, other important discriminatory dimensions are sex and gender. Women’s toilets are <a href="https://www.sciencedirect.com/science/article/pii/0277539595800946?via%253Dihub">frequently undersized</a> compared to men’s – despite menstruation, pregnancy and caring responsibilities for small children which all necessitate more frequent and longer bathroom use. This design flaw is a standard that has existed for decades and has only <a href="https://www.researchgate.net/profile/Clara_Greed/publication/228916130_A_Code_of_Practice_for_Public_Toilets_in_Britain/links/55bf109008ae9289a099e004/A-Code-of-Practice-for-Public-Toilets-in-Britain.pdf">recently been reviewed</a>.</p>
<p>While secrecy around menstruation is often <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235339">highlighted in other societies</a>, it is easy to overlook the culture of silence around periods in the UK, which <a href="https://journals.sagepub.com/doi/10.1177/0038026119854253">compounds inadequate provision</a> of facilities for women and menstruating people. Public toilets can also be <a href="https://www.theguardian.com/commentisfree/2018/oct/03/public-bathrooms-are-gender-identity-battlefields-what-if-we-just-do-it-right">uncomfortable or even hostile</a> environments for trans and non-binary people – particularly when gender-neutral facilities aren’t available. </p>
<p>This sort of discrimination is compounded by the <a href="https://www.bbc.co.uk/news/uk-45009337">reduction of public toilet provision</a> over the past decade, and can result in the digestive system and periods becoming a “<a href="https://www.tandfonline.com/doi/abs/10.1080/713668884">leash</a>”, preventing some people from venturing far in case there is no access to a toilet.</p>
<p>Cleaning and maintenance of toilets is vital. But sanitation workers and cleaners remain largely <a href="https://washmatters.wateraid.org/blog/the-unsung-heroes-of-the-covid-19-pandemic">unrecognised and undervalued</a>, even though their public health contribution should <a href="https://leftfootforward.org/2020/08/after-pay-rise-luton-hospital-cleaners-still-wont-earn-a-living-wage/?mc_cid=04ababaf1e&mc_eid=07f10b9f05">arguably receive similar</a> appreciation to that of porters and cleaners in hospitals. Instead of being protected, toilet cleaners – among other typically low-paid but essential workers – are <a href="https://theconversation.com/coronavirus-class-divide-the-jobs-most-at-risk-of-contracting-and-dying-from-covid-19-138857">more at risk</a> of contracting and dying from COVID-19.</p>
<p>This highlights another humbling truth for the UK: discriminatory treatment of sanitation workers is not an issue reserved only for <a href="https://www.who.int/news-room/detail/14-11-2019-new-report-exposes-horror-of-working-conditions-for-millions-of-sanitation-workers-in-the-developing-world">LMICs</a>, but occurs within our society too.</p>
<h2>A better future</h2>
<p>Easing of lockdown has prompted urgent discussion about how to reopen public toilets safely. <a href="https://www.bbc.co.uk/news/uk-52774794">Innovations</a> such as foot-operated flush pedals, one-way systems and sensors for water, soap, paper towels and bins reduce shared touchpoints and proximity. But this is a timely opportunity to consider how <a href="https://journals.sagepub.com/doi/10.1177/0038026119854274">equitable</a> and suitable provision for women, trans and non-binary people, and the needs of disabled people can be addressed. The economic and societal benefits of adequate public toilets have never been clearer.</p>
<p>The crisis also highlights the importance of responsible attitudes towards the <a href="https://blog.bham.ac.uk/business-school/2020/04/22/how-societies-respond-to-social-distancing-orders/">collective</a> good. Many actions can be taken by individuals to reduce asymptomatic spread, from wearing a mask to diligent handwashing and <a href="https://www.telegraph.co.uk/global-health/climate-and-people/put-seat-flushing-toilet-avoid-spread-covid-19-scientists-urge/">closing the toilet lid</a> after use.</p>
<p>As <a href="https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-news-lockdown-end-uk-hairdressers-pubs-reopen-hotels/">bars, pubs, and other places reopen</a>, a sense of personal responsibility towards societal health, and respect for sanitation workers who facilitate it, will be more<a href="https://doi.org/10.1016/j.envint.2020.105790"> important</a> than ever.</p>
<p>Toilets function as a bridge between public and private spaces, signifying who should and shouldn’t be present. They stand as <a href="https://www.jstor.org/stable/24461652">political symbols of power and inclusion</a>. With COVID-19 reshaping how we move and interact in public spaces, it is time to recognise the importance of public toilets – and the people who look after them – to equitable, dignified and healthy participation in public life. Now more than ever, we must appreciate that nature’s call can only be put on hold for so long.</p><img src="https://counter.theconversation.com/content/143218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Boyd Williams receives funding from NERC for her PhD. </span></em></p><p class="fine-print"><em><span>Heather Roxburgh receives funding from NERC, the Parkes Foundation, and the Royal Geographical Society for her PhD. </span></em></p><p class="fine-print"><em><span>Jennifer Dickie received funding from the Scottish Alliance for Geosciences, Environment & Society (PECRE award) to investigate the links between energy and sanitation in India and NERC funding for Natalie Boyd Williams' PhD studentship. </span></em></p>Coronavirus has amplified the fact that inadequate toilet access has long been a feature of UK life for many, including women and the disabled. Vulnerable people deserve better.Natalie Boyd Williams, PhD Researcher, University of StirlingHeather Roxburgh, PhD student, University of StirlingJennifer Dickie, Lecturer in Environmental Geography, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1009812018-08-06T09:12:02Z2018-08-06T09:12:02ZStem cell transplants to be used in treating Crohn’s disease<figure><img src="https://images.theconversation.com/files/230554/original/file-20180803-41366-1k4y2sv.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C986%2C546&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/588244520?src=nmp9YmNs2r6XAIpaLow_5A-1-27&size=medium_jpg">Teerawit Chankowet/Shutterstock.com</a></span></figcaption></figure><p>A new trial to assess the benefits and safety of stem cell transplantation for treatment-resistant Crohn’s disease has started. The researchers will use stem cells to “reboot” the immune system so that it is more responsive to existing drugs used to treat the disease.</p>
<p>Crohn’s disease is a long-term condition that results in inflammation of the lining of the digestive system. It affects as many as two people per 1,000 and is becoming more <a href="https://www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease">common</a>. </p>
<p>People who have Crohn’s disease can suffer from diarrhoea, abdominal pain, extreme tiredness and weight loss. Untreated, the disease has a significant impact on quality of life. Although Crohn’s disease can occur at any age, it usually manifests itself in adolescence. </p>
<p>The exact cause is not clear, but we known that <a href="https://www.ncbi.nlm.nih.gov/pubmed/26255561">genes</a> and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26627550">environment</a> play an important role. The inflammation in Crohn’s disease is caused by “allergic reactions” in the immune cells that line the gut to the normal bacteria that exist in all of our intestines. </p>
<p>Current treatments, including steroids, aim to suppress this immune reaction. In the last decade, there have been great advances in treatments including targeted biological <a href="https://www.ncbi.nlm.nih.gov/pubmed/27914655">therapies</a> that can heal the gut. However, these treatments don’t work for all patients, and some who initially respond well may loose their response over time. </p>
<p>Most treatments have side effects, including a risk of infection. Ongoing active disease can eventually cause blockage in the gut or abscesses that may need surgery to remove the affected section. </p>
<p>Although surgery may be the best option for some people, the disease nearly always recurs at a later date. Having many operations leaves people at risk of malnutrition and may require the formation of a stoma. This is when a surgeon brings a loop of bowel out through an opening created on the abdominal wall so that so that faeces empties into an attached bag.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/230556/original/file-20180803-41338-1x76ane.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some patients eventually need a stoma.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/703895749?src=18N3r_vuFyTuJ2sgnOK1NA-1-2&size=medium_jpg">Nalada Naga/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Eight sites</h2>
<p>The new trial, that has been launched at eight sites across the UK, involves the use of stem cells to treat Crohn’s disease. Stem cells are the multipurpose parent cells that live in our bone marrow and grow into the normal immune system. Stem cell transplantation aims to remove a patient’s current immune cells and replace them with fresh cells grown from their own stem cells. The purpose of this is to reset the immune system so that it no longer reacts to the gut bacteria. </p>
<p>Recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/29934135">research</a> has shown stem cell transplantation to be very effective in treating other autoimmune disease, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/29053779">multiple sclerosis</a>. </p>
<p>Our trial, called ASTIClite, will investigate whether transplantation can reduce gut inflammation and offer hope to people with Crohn’s disease for whom all other treatments have been unsuccessful. </p>
<p>ASTIClite is a follow up to our previous <a href="https://www.ncbi.nlm.nih.gov/pubmed/26670970">ASTIC trial in 2015</a>, which investigated a similar stem cell therapy. Although the therapy in the original trial did not cure the disease, we found that many patients <a href="https://www.ncbi.nlm.nih.gov/pubmed/28497755">benefited from the treatment</a>. However, there were some serious side effects from the doses of strong drugs that were used to destroy their faulty immune system. This follow up trial is using a much lower dose of these drugs to minimise the risk of side effects.</p>
<p>In the ASTIClite trial, patients will be randomly allocated to receive either the stem cell transplant or current standard care, which can include any currently available treatment for Crohn’s disease. </p>
<p>The transplant process involves patients receiving immune suppressing drugs and growth factor injections that stimulate the stem cells to multiply in the bone marrow and spill out into the blood so that they can be harvested and frozen for later use. Strong drug therapy is then used to wipe out their faulty immune system. </p>
<p>When the stem cells are reintroduced to the body, they develop a fresh immune system. It is also thought that the new immune system may respond to drugs that have previously lost their benefit. This means that even if the stem cell transplant doesn’t “cure” a patient’s Crohn’s disease, it may allow them to respond to a drug treatment that had previously not worked.</p>
<p>All patients will come to clinics for around a year after their stem cell transplant, or equivalent for the standard of care group, and will complete questionnaires on their symptoms and quality of life. Patients will also have blood tests, MRI scans and colonoscopies at various points during this period. </p>
<p>Importantly, we will carefully assess the safety of this new treatment. Patients are then invited to attend an annual follow up visit for a further four to seven years so that we can look at their symptoms and quality of life over a longer period of time, and compare the course of the disease after a stem cell transplant with that of the standard of care group. We expect to publish results in late 2022.</p>
<p>If the stem cell transplant is shown to improve the symptoms and quality of life for patients with Crohn’s disease, this will be an important advance in treating the disease in patients who haven’t responded to standard treatments.</p><img src="https://counter.theconversation.com/content/100981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:james.lindsay@bartshealth.nhs.uk">james.lindsay@bartshealth.nhs.uk</a> receives funding from the Medical Research Council, The National Institute of Health Research, Crohn's and Colitis UK, The Barts Charity, Bowel and Cancer Research, The Rosetrees Foundation, Pfizer, Takeda and Shire.</span></em></p>A large trial to test whether rebooting the immune system will help patients with Crohn’s disease has just begun.James Lindsay, Professor of Inflammatory Bowel Disease, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/788412017-07-16T19:57:59Z2017-07-16T19:57:59ZThe brain and the gut talk to each other: how fixing one could help the other<figure><img src="https://images.theconversation.com/files/176843/original/file-20170705-15991-khi2jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with chronic bowel conditions may need to use the toilet 20 to 30 times a day.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/daveynin/4753012363/in/photolist-8f1qZ2-iWhuse-7u2KbS-bxbRFV-Fq8rbJ-5b878q-nUSaon-4r8Qm8-LKwH5-6n3yth-bdeJRa-6U13A3-5C7aE6-8EqfxB-iDrDsb-JtEDwA-8xwJn6-835Bi5-aoTP7D-bDxGVx-byLg7S-dtxhQJ-a5fxwE-bx1P3e-EK9aF-NKvr4Z-JmPm4u-6fSMwj-bnrRHW-iYFAj6-pvkPrB-dkTtSc-b1FAye-2WH8ay-8xjqcX-bwu8vK-jvxQ6o-fpprtj-db4qc-699kYH-wJNJH-b7T4yt-ckkMiL-dwpTPu-nT5DdF-8aRBjT-fMemM-am2Swr-2CCiog-dVB5dV">daveynin/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>It’s widely recognised that emotions can directly affect stomach function. As early as 1915, influential physiologist <a href="https://archive.org/details/cu31924022542470">Walter Cannon noted</a> that stomach functions are changed in animals when frightened. The same is true for humans. Those who <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1440-174%206.2004.03508.x/full">stress a lot</a> often report diarrhoea or stomach pain.</p>
<p>We now know this is because the brain communicates with the gastrointestinal system. A whole ecosystem comprising <a href="http://www.nature.com/nature/journal/v449/n7164/full/nature06244.html">100 trillion bacteria</a> living in our bowels is an active participant in this brain-gut chat.</p>
<p>Recent discoveries around this relationship have made us consider using talk therapy and antidepressants as possible treatments for symptoms of chronic gut problems. The aim is to interfere with the conversation between the two organs by telling the brain to repair the faulty bowel.</p>
<p>Our research found <a href="http://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30206-0/abstract">talk therapy can improve depression</a> and the quality of life of patients with gastrointestinal conditions. Antidepressants may also have a <a href="http://journals.lww.com/ibdjournal/fulltext/2017/04000/Antidepressants_in_Inflammatory_Bowel_Disease___A.6.aspx">beneficial effect</a> on both the course of a bowel disease and accompanying anxiety and depression.</p>
<h2>What are gastrointestinal conditions?</h2>
<p>Gastrointestinal conditions are incredibly common. About <a href="http://www.gastrojournal.org/article/S0016-5085(97)00250-3/abstract">20% of adults and adolescents</a> suffer from irritable bowel syndrome (IBS), a disorder where abdominal discomfort or pain go hand-in-hand with changes in bowel habits. These could involve chronic diarrhoea and constipation, or a mixture of the two. </p>
<p>IBS is a so-called functional disorder, because while its symptoms are debilitating, there are no visible pathological changes in the bowel. So it is diagnosed based on symptoms rather than specific diagnostic tests or procedures.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176848/original/file-20170705-21549-xixeme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People with chronic gut conditions can experience severe pain that affects their quality of life.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>This is contrary to inflammatory bowel disease (IBD), a condition where the immune system reacts in an exaggerated manner to normal gut bacteria. Inflammatory bowel disease is associated with bleeding, diarrhoea, weight loss and anaemia (iron deficiency) and can be a cause of death. It’s called an organic bowel disease because we can see clear pathological changes caused by inflammation to the bowel lining. </p>
<p>Subtypes of inflammatory bowel disease are Crohn’s disease and ulcerative colitis. Around <a href="https://worldibdday.org/about-us">five million people worldwide</a>, and more than <a href="https://www.crohnsandcolitis.com.au/site/wp-content/uploads/Australian_Educator_Autumn_2014.pdf">75,000 in Australia</a>, live with the condition.</p>
<p>People with bowel conditions may need to use the toilet 20 to 30 times a day. They also suffer pain that can affect their family and social lives, education, careers and ability to travel. Many experience anxiety and depression in response to the way the illness changes their life. But studies also suggest those with <a href="http://gut.bmj.com/content/61/9/1284.long">anxiety</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18796096">depression</a> are more likely to develop bowel disorders. This is important evidence of brain-gut interactions.</p>
<h2>How the brain speaks with the gut</h2>
<p>The brain and gut <a href="http://www.sciencedirect.com/science/article/pii/S0016508509003461?via%3Dihub">speak to each other constantly</a> through a network of neural, hormonal and immunological messages. But this healthy communication can be disturbed when we stress or develop chronic inflammation in our guts.</p>
<p>Stress can influence the type of bacteria inhabiting the gut, making our bowel flora less diverse and possibly more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039072/">attractive to harmful bacteria</a>. It can also <a href="http://www.sciencedirect.com/science/article/pii/S001650851201493X?via%3Dihub">increase inflammation</a> in the bowel, and vulnerability to infection.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174838/original/file-20170621-30161-2l3p36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ever ‘gone with your gut’ when making a decision? You’re probably receiving signals from your gastrointestinal tract, which communicates directly with your brain.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Chronic intestinal inflammation may lower our sensitivity to positive emotions. When we become sick with conditions like inflammatory bowel disease, our <a href="https://insights.ovid.com/pubmed?pmid=21744432">brains become rewired</a> through a process called neuroplasticity, which changes the connections between the nerve signals. </p>
<p>Anxiety and depression are common in people suffering chronic bowel problems. Approximately 20% of those living with inflammatory bowel disease <a href="https://insights.ovid.com/pubmed?pmid=26841224">report feeling anxious or blue</a> for extended periods of time. When their disease flares, this rate may exceed 60%. </p>
<p>Interestingly, in a <a href="http://www.cghjournal.org/article/S1542-3565(16)00047-1/fulltext">recent large study</a> where we observed 2,007 people living with inflammatory bowel disease over nine years, we found a strong association between symptoms of depression or anxiety and disease activity over time. So, anxiety and depression are likely to make the symptoms of inflammatory bowel disease worse long-term.</p>
<p>It makes sense then to offer psychological treatment to those with chronic gut problems. But would such a treatment also benefit their gut health?</p>
<hr>
<p><em><a href="https://theconversation.com/gut-feeling-how-your-microbiota-affects-your-mood-sleep-and-stress-levels-65107"><strong>Gut feeling: how your microbiota affects your mood, sleep and stress levels</strong></a></em></p>
<hr>
<h2>Inflammatory bowel disease</h2>
<p>Our <a href="http://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30206-0/abstract">recent study</a> combined data from 14 trials and 1,196 participants to examine the effects of talk therapy for inflammatory bowel disease. We showed that talk therapy - particularly cognitive behavioural therapy (CBT), which is focused on teaching people to identify and modify unhelpful thinking styles and problematic behaviours - might have short-term beneficial effects on depression and quality of life in people with inflammatory bowel disease. </p>
<p>But we did not observe any improvements in the bowel disease activity. This could be for several reasons. Inflammatory bowel disease is hard to treat even with strong anti-inflammatory drugs such as steroids, so talk therapy may not be strong enough. </p>
<p>Talk therapy may only help when it’s offered to people experiencing a flare up in their disease. The majority of the included studies in our review were of people in remission, so we don’t know if talk therapy could help those who flare. </p>
<p>On the other hand, in our <a href="http://journals.lww.com/ibdjournal/fulltext/2017/04000/Antidepressants_in_Inflammatory_Bowel_Disease____A.6.aspx">latest review</a> of 15 studies, we showed antidepressants had a positive impact on inflammatory bowel disease as well as anxiety and depression. It’s important to note the studies in this review were few and largely observational, which means they showed associations between symptoms and antidepressant use rather than proving antidepressants caused a decrease in symptoms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176866/original/file-20170705-16505-1jhx2we.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Studies show talk therapy improves the symptoms of irritable bowel syndrome.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Irritable bowel syndrome</h2>
<p>When it comes to irritable bowel syndrome, the studies are more conclusive. According to a meta-analysis combining 32 trials,
both <a href="http://gut.bmj.com/content/58/3/367">talk therapy and antidepressants</a> improve bowel symptoms in the disorder. A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/24935275">update to this meta-analysis</a>, including 48 trials, further confirmed this result.</p>
<p>The studies showed symptoms such as diarrhoea and constipation improved in 56% of those who took antidepressants, compared to 35% in the group who received a placebo. Abdominal pain significantly improved in around 52% of those who took antidepressants, compared to 27% of those in the placebo group. </p>
<p>Symptoms also improved in around 48% of patients receiving psychological therapies, compared with nearly 24% in the control group, who received another intervention such as usual management. IBS symptoms improved in 59% of people who had cognitive behavioural therapy, compared to 36% in the control group. </p>
<p>Stress management and relaxation were found to be ineffective. Interestingly, hypnotherapy was also found effective for bowel symptoms in 45%, compared to 23% of control therapy participants.</p>
<h2>What now?</h2>
<p>Better studies exploring the role of talk therapy and antidepressants for symptoms of inflammatory bowel disease need to be conducted. We should know in a few years which patients are likely to benefit.</p>
<p>In the meantime, there is enough evidence for doctors to consider referring patients with irritable bowel syndrome for talk therapy and antidepressants.</p><img src="https://counter.theconversation.com/content/78841/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Antonina Mikocka-Walus has received research grants from the Crohn's and Colitis Foundation of America, the Broad Foundation, Crohn's & Colitis Australia, the Wellcome Trust, ForCrohns, Janssen Australia, Abbott Australia, Department of Health and Aging.</span></em></p>Our brain and gut are constantly talking to each other, so it makes sense mental health and stomach issues have a close relationship.Antonina Mikocka-Walus, Senior Lecturer in Health Psychology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/503302015-12-10T19:22:13Z2015-12-10T19:22:13ZThalidomide: the drug with a dark side but an enigmatic future<p>The drug thalidomide has a notorious past. It was used between 1957-62 as a sedative and to treat morning sickness in early pregnancy but a serious side effect resulted in <a href="http://www.sciencemuseum.org.uk/broughttolife/themes/controversies/thalidomide.aspx">over 10,000 children born</a> with severe birth defects. </p>
<p>How the drug caused these defects, which could affect most parts of the body and includes phocomelia – where the limbs are shortened and missing the long bones with the digits in some cases extruding from the shoulder or the hip – is becoming clearer. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/bdrc.21096/abstract">Recent work</a> has shown that the drug is able to inhibit the formation of new blood vessels, induce cell death as well as bind to molecular <a href="http://www.nature.com/nsmb/journal/v21/n9/full/nsmb.2874.html">targets such as cereblon</a>, a protein that alters the function of other molecules to regulate signalling, are all likely responsible for the birth defects the drug caused. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101434/original/image-20151110-21228-17fvoc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One of the darkest episodes in research history.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/22719239@N04/2241322031/in/photolist-bjhCnK-4q4mXi-aq5hjE-atCPtk-atDsVx-6agmPN-a96Rfj-k6J1WY-bjhR1z-nWtX5N-iusm61-kkJDJn-swF8rh-m4cNhp-ecmdaE-au1YxZ-dbvsSA-dbvsQd-45kyL-5LUNZK-nefquF-7wwzT3-6nqtot-6nuDim-6nuCpb-x842So-6nuDjw-6nuCPS-6nuC1m-6hxVmX-7o28p5-wGDnRB-8yc7kE-ypEZg-7LpCXQ-69gTqo-7y3QwM-9ToAi-j6F7n-8NxJ6R-EADf7-jEmf-bT66D-8wFWVc-6BNpgu-9vPQ34-6Htc4j-4DDWR8-7w9f5x-mify8">Otis Historical Archives National Museum</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Other uses</h2>
<p>Despite the catastrophic actions of the drug when used in pregnant women, thalidomide is now enjoying a renaissance. Thalidomide has been shown to possess a potent ability to inhibit the body’s inflammatory response as well as prevent blood vessel formation in the adult. It is now being used successfully in a wide range of clinical conditions <a href="https://theconversation.com/how-thalidomide-became-one-of-the-most-talked-about-drugs-in-cancer-therapy-32194">from cancer</a> to leprosy. </p>
<p>Surprisingly, it was just a few years after the thalidomide disaster that the drug was found to be effective for the treatment of <a href="http://www.who.int/lep/research/WHOenlguide.pdf">Erythema nodosum leprosum</a> (ENL), a complication of leprosy, where painful and inflamed skin lesions occur on the face, arms and legs. Leprosy is seen in tropical and subtropical areas and is particularly prevalent in Brazil and India. Thalidomide is used widely in Brazil to treat this condition, despite the World Health Organization advising against the use of thalidomide <a href="http://www.who.int/lep/research/thalidomide/en/">for leprosy treatment</a>.</p>
<p>Thalidomide is also very effective for the treatment of multiple myeloma, a cancer of white blood cells. As part of a treatment regime, thalidomide <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdrc.21096/abstract">has been shown</a> to prolong the lives of myeloma patients by up to 18 months. The continued study of the drugs ability to prevent new blood vessel formation and its anti-inflammatory capabilities have led to the discovery and marketing of two structurally-related <a href="http://www.drugs.com/dict/analogue.html">analogs</a> of the drug – Lenalidomide and Pomalidomide – that are more potent than thalidomide and <a href="http://www.hindawi.com/journals/isrn/2013/241016/">which are used to treat multiple myeloma</a> and complications of this condition.</p>
<p>The mechanism by which these analogs are so effective against multiple myeloma <a href="https://www.sciencemag.org/content/343/6168/256">was recently described</a> where the drug binds to Cereblon which has the ability – by altering the function of several other cellular molecules – to selectively kill off myeloma cells.</p>
<p>Thalidomide has also been used to treat Crohns Disease, a nasty inflammatory condition affecting the digestive system <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdrc.21096/abstract">with varying success</a>. </p>
<p>It has also been used to treat HIV and complications of HIV, such as Karposi’s sarcoma and several cancers including prostate cancer and brain tumours. </p>
<p>Thalidomide has also been used to treat Behcets disease (an immune system induced vascular condition where vessels are destroyed causing bleeding and tissue damage), as well as graft versus host disorders such as tissue transplants to reduce the chances the host will reject the transplant. </p>
<p>Thalidomide is also effective in the treatment of Hereditary hemorrhagic telangiectasia (HHT) a condition where vessels form abnormally and cause bleeding into organs <a href="http://www.nature.com/nm/journal/v16/n4/full/nm.2131.html">and from the skin and nose</a>. Thalidomide prevents blood vessel formation and causes stabilisation of the vessels to prevent bleeding.</p>
<h2>Unheeded warnings</h2>
<p>Thalidomide remains clinically very useful yet long-term use is not recommended due to the ability of the drug to cause peripheral neuropathy, a painful condition that results from damage to the nerves in the body extremities.</p>
<p>Sadly, thalidomide and its analogs still also have the ability to cause birth defects in the developing embryo. To prevent damage being done the US Food and Drug Administration and the EU insist that these drugs should only be taken as part of a carefully regulated and controlled scheme that includes regular pregnancy testing. </p>
<p>Because of this careful regulation, there have been no cases of thalidomide-induced birth defects in Europe or the US since the original disaster. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=288&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=288&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=288&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=362&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=362&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101436/original/image-20151110-21195-1j7mn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=362&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Celgene: approved for use in Europe, US and Australia.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/duckwalk/9636420141/in/photolist-fFxaYR-bjhNqM-ohKuME-bjhCnK-4q4mXi-aq5hjE-atCPtk-atDsVx-6agmPN-a96Rfj-k6J1WY-bjhR1z-nWtX5N-iusm61-kkJDJn-swF8rh-m4cNhp-ecmdaE-au1YxZ-dbvsSA-dbvsQd-45kyL-5LUNZK-nefquF-7wwzT3-6nqtot-6nuDim-6nuCpb-x842So-6nuDjw-6nuCPS-6nuC1m-6hxVmX-7o28p5-wGDnRB-8yc7kE-ypEZg-7LpCXQ-69gTqo-7y3QwM-9ToAi-j6F7n-8NxJ6R-EADf7-jEmf-bT66D-8wFWVc-6BNpgu-9vPQ34-6Htc4j">Duck Wailk</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Tragically, however, the opposite is the case <a href="http://journals.lww.com/clindysmorphol/Abstract/2013/04000/Recognition_of_the_phenotype_of_thalidomide.4.aspx">in other parts of the world</a>, notably Brazil where the drug is used widely to treat leprosy complications. Villages in areas endemic with leprosy are often very far from medical help and so a medicine sharing culture exists, and sadly a new generation of thalidomide damaged children have recently <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdrc.21096/abstract">been identified in Brazil</a>.</p>
<p>Research into forms of thalidomide that have the clinical benefits but not the side-effects – specifically to prevent its ability to cause birth defect in embryos but also its neurotoxic actions in adults – <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdrc.21096/abstract">are underway</a> but this remains a major challenge. </p>
<p>Studying how analogs or structural variants of the drug work and their functions in the body, as well as determining their molecular mechanism/s of action, will shed light on how these drugs act and allow studies into whether the compounds could be useful to treat other conditions including inflammatory conditions such as arthritis.</p>
<p>Such an understanding can also help aid safer and more targeted drug design to combat specific conditions without actions on other tissues or side effects that cause pain.</p>
<p><em>This is the final article on our <a href="https://theconversation.com/au/topics/thalidomide">thalidomide series</a>. Read the other instalments <a href="https://theconversation.com/au/topics/thalidomide">here</a>.</em></p><img src="https://counter.theconversation.com/content/50330/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neil Vargesson receives or has received funding for thalidomide research from the Wellcome Trust, the Royal Society, University of Aberdeen, Imperial College London.
I have previously been consulted by and acted on behalf of lawyers looking for advice on thalidomide.
I have previously been part of a World Health Organisation meeting looking at Thalidomide Embryopathy and criteria for diagnosis and causation.</span></em></p>Thalidomide is notorious for causing death and disability but it – and its derivatives – are proving useful for conditions such as leprosy.Neil Vargesson, Senior Lecturer in Developmental Biology, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/380132015-02-27T06:29:25Z2015-02-27T06:29:25ZMolecular ‘GPS’ helps stem cells navigate inside the body<figure><img src="https://images.theconversation.com/files/73222/original/image-20150226-1754-xjrnzd.jpg?ixlib=rb-1.1.0&rect=5%2C383%2C3932%2C2499&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Saving lives, one ear at a time.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-210003694/stock-photo-scientist-holding-white-laboratory-mouse-mus-musculus-in-hands.html?src=csl_recent_image-2&ws=1">Mirko Sobotta//Shutterstock</a></span></figcaption></figure><p><a href="http://www.cell.com/cell-reports/abstract/S2211-1247%2815%2900099-6">Recent research</a> has identified a novel molecule that could help localise stem cells within the body. Cell therapy holds significant promise for treating a wide range of diseases and tissue defects including arthritis, cardiovascular disease, multiple sclerosis and Crohn’s disease. But in current therapies, most cell types do not reach diseased or damaged tissues efficiently.</p>
<p>Controlling cells once they have been introduced into the body is a key challenge to overcome. There are all kinds of tools and techniques that can be used to manipulate cells outside of the body in a petri dish and get them to do almost anything we want. But once cells have been transplanted, it is difficult to control them. We have now been able to identify small molecules that can be used to treat cells before injection into the body, programming them to target blood vessels in diseased or damaged tissue once inside the body. </p>
<p>This molecular targeting is especially important in the case of adult mesenchymal stem cells (MSCs), which are known to secrete several therapeutic factors and are being explored in more than 450 clinical trials. A major challenge has been getting MSCs to target – and stay at – sites of damage within the body, where they can secrete high levels of therapeutic factors to suppress inflammation and promote recovery.</p>
<p>Our team of bio-engineers from Brigham and Women’s Hospital and imaging experts at the Massachusetts General Hospital (led by Charles Lin), with collaborators at the pharmaceutical company Sanofi, has identified small molecules that can be used to program stem cells to home in on sites of damage, disease and inflammation. We tested more than 9,000 compounds for their ability to send stem cells in the right direction. We used a multi-step approach – including a sophisticated micro-scale set up and a novel imaging technique – to select and test the most promising compounds.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73223/original/image-20150226-1754-uwau3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">8,888…8,999…9,000!!</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-114690883/stock-photo-stem-cell-research-in-the-pcr-strip.html?src=zrYkycI0e0DVD_b1xzVtNg-1-0&ws=1">science photo/Shutterstock</a></span>
</figcaption>
</figure>
<h2>A molecular navigation system</h2>
<p>We had <a href="http://www.ncbi.nlm.nih.gov/pubmed/22034631">previously found</a> that it is possible to use bioengineering techniques to chemically attach molecules to the surface of a cell, to act as a GPS, guiding the cell to the site of inflammation. </p>
<p>Screening thousands of compounds, looking for ones that activated key molecules on the surface of the MSCs, we found six promising molecules, including one known as Ro-31-8425, the most potent of the group. We treated cells with each of these promising molecules and then flowed the cells into microscale glass channels, to simulate the flow of cells in the bloodstream. The glass channels were coated with a protein which is also found on the surface of blood vessels at inflamed tissue within the body. Cells pre-treated with Ro-31-8425 stuck to the coated channels – a sign that they might be able to home in on sites of inflammation. </p>
<p>The next step was to test our cells in an animal. We injected cells that had been pre-treated with Ro-31-8425 into the blood stream of a mouse with one inflamed ear. We then examined both ears using unique real-time microscopy, a technique that allows researchers to capture images of tissue in live animals. We observed that the cells treated with the compound not only homed in on the inflamed ear, but also reduced inflammation.</p>
<p>These findings, along with the multi-step screening platform we developed, have the potential to improve delivery of injected stem cells to sites of disease, where they can release their therapeutic cargo at high levels. This will greatly boost the clinical impact of cell-based therapies in treating life-threatening diseases.</p><img src="https://counter.theconversation.com/content/38013/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was supported by a research grant from Sanofi-Aventis U.S. to Jeffrey Karp and Charles Lin, and by National Institutes of Health grants HL095722 to Jeffrey Karp and P41 EB015903-02S1 to Charles Lin.</span></em></p><p class="fine-print"><em><span>Oren Levy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A novel molecule has been used to target stem cells to damaged tissues within the body, allowing more efficient cell therapy for the treatment of arthritis, Crohn’s, cardiovascular disease and MSJeffrey Karp, Associate Professor of Medicine, Harvard UniversityOren Levy, Post-doctoral Researcher, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/151732013-07-23T20:11:57Z2013-07-23T20:11:57ZExplainer: what is inflammatory bowel disease?<figure><img src="https://images.theconversation.com/files/27911/original/kv5ygnkb-1374563238.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Inflammatory bowel disease is one of a variety of unrelated but ongoing gastrointestinal disorders.</span> <span class="attribution"><span class="source">J.B. Hill</span></span></figcaption></figure><p><a href="http://www.cdc.gov/ibd/">Inflammatory bowel disease</a> is a group of inflammatory conditions of the colon and small intestine that can cause life-threatening complications and may require surgery. Luckily, current therapies offer real benefits and there are some <a href="http://www.mayoclinic.org/medicalprofs/ibd-pipeline-drugs-pudd0412.html">promising drugs</a> in the pipeline.</p>
<p>The disease is one of a variety of unrelated but ongoing gastrointestinal disorders. Of these, some of the most common complaints are about gluten intolerance and functional bowel problems (when the gut doesn’t work properly, such as when someone has irritable bowel syndrome). Crohn’s disease and ulcerative colitis are examples of inflammatory bowel disease. </p>
<p>All of these problems have very different causes, although having one of them may put you at an increased risk of developing another.</p>
<h2>Causes and effects</h2>
<p>The precise causes of inflammatory bowel disease <a href="http://www.med.unc.edu/gi/specialties/ibd/about-ibd/what-causes-inflammatory-bowel-diseases-ibd">are not known</a>. What we do know is that, in general, people with inflammatory bowel disease are likely to have a genetic predisposition for the disease. Their genes make it more likely that they will develop inflammatory bowel disease although they may never do so. </p>
<p>If they develop the disease, it’s most likely because of an environmental trigger – stress, for instance, or malnutrition or certain drugs. But, in most people, the trigger may never be known. </p>
<p>Factors in the gut, such as a disruption in the balance between good and bad bacteria, can also contribute to the onset of the disease.</p>
<p>The effect of inflammatory bowel disease on the gut is actually caused by the person’s immune system. Once activated, the disease attacks the body’s cells instead of foreign cells such as bacteria, fungi or viruses. </p>
<p>This initiates the sort of angry red inflammation in the gut that would normally get rid of infections. Unfortunately, in the case of inflammatory bowel disease, the immune system reacts to bacteria that are normally resident in the gut. And, in so doing, the disease causes severe damage that can cause a perforation (a hole through the wall of the gut). </p>
<p>This is a life-threatening event and, at this point, surgery is the only treatment option. The many surgeries some people suffering from inflammatory bowel disease have to undergo during their life is extremely burdensome. </p>
<p>But there’s an indirect benefit for the community in this – the resulting surgical samples can sometimes be used to help researchers who are trying to find a cure for inflammatory bowel disease.</p>
<h2>Current and new treatments</h2>
<p>Inflammatory bowel disease is not active all the time – it is prone to flare-ups that are separated by quiet times during which the disease is in remission. This makes treatment more complicated because it can be hard to know if the remission is caused by a new drug or if it’s spontaneous. </p>
<p>Most cases of inflammatory bowel disease are initially handled by giving the sufferer an anti-inflammatory drug that will hopefully induce remission. Once in remission, many patients take immunosuppressant drugs that decrease the likelihood of another flare-up. </p>
<p>Immunosuppressants are drugs that modify how the immune system works and generally lower its activity. Many new drugs that fall into this general class are being developed. </p>
<p>With the immune attack reduced, the gut can often heal on its own and stay healthy for longer. Current treatment strategies generally start with older drugs but if these fail, <a href="http://en.wikipedia.org/wiki/Biological_therapy_for_inflammatory_bowel_disease">biological therapies</a>, such as infliximab, are tried. A biological therapy also targets the immune system. The active compounds often originate from human, animal or bacterial sources - for example, infliximab is an antibody. </p>
<p>These drugs are effective in many people but they can have severe side-effects and become less effective over time.</p>
<p><a href="http://www.nature.com/nrd/journal/v12/n6/full/nrd4037.html">Three new such drugs</a> (all using the same approach) are currently undergoing the lengthy regulatory approval process overseas. They inhibit a protein in the body called an “integrin”, which helps cells stick together. In inflammatory bowel disease, the integrins are what allow immune cells to invade the intestine and start the inflammatory process.</p>
<p>The role of integrins has been known for many years, but the problem is that they are located everywhere in the body. Drugs that block all integrins are dangerous for various reasons, for example, because blood clotting is dependent on integrins. </p>
<p>These new drugs block only one specific type of integrin and seem to be safe and effective. They target a kind of integrin that is only found on some white blood cells that are crucial for an immune response in inflammatory bowel disease. </p>
<p>To date, these drugs have been mainly tested on patients who have already failed using current therapies. There’s hope that once these drugs are registered, they will find an earlier use in less severely affected patients.</p>
<p>It’s likely that one or more of these new drugs will get regulatory approval before long, but it may be another four or five years before they would be prescribed to patients. Clinical trials to monitor their safety and effectiveness will be required first.</p><img src="https://counter.theconversation.com/content/15173/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Bertrand receives funding from National Health and Medical Research council for projects relating to gastrointestinal health.</span></em></p><p class="fine-print"><em><span>Lu Liu receives funding from National Health and Medical Research Council.</span></em></p>Inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine that can cause life-threatening complications and may require surgery. Luckily, current therapies offer…Paul Bertrand, Senior Lecturer in School of Medical Sciences, RMIT UniversityLu Liu, Senior Lecturer in Pharmacology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.