A University of Virginia undergraduate’s research might explain why Crohn’s disease keeps returning in children and could lead to new treatments or even a cure.
Crohn’s disease causes severe inflammation in the digestive tract, leading to symptoms like abdominal pain, weakness, fatigue, and malnutrition. While it mainly affects adults, tens of thousands of children in the U.S. suffer from it, causing major disruptions in their lives, schooling, growth, and development. Some children may even need surgery to remove parts of their intestines.
New UVA research suggests that children with recurring Crohn’s disease have ongoing disruptions in their gut microbiomes, even after successful inflammation treatment. Undergrad Rebecca Pierce, guided by Dr. Chelsea Marie, made this discovery, which may help explain why these children experience repeated flare-ups.
The link between gut bacteria imbalance and inflammation in Crohn’s disease has been a long-standing question. Rebecca used a pediatric group at UVA to show that even when inflammation was controlled, gut bacteria imbalances remained,” said Dr. Marie from UVA’s Department of Medicine. “Our study suggests that ongoing bacterial imbalances might play a crucial role in the disease in children.”
This insight could help doctors develop better treatments or a cure for Crohn’s. Most Crohn’s treatments currently focus on managing symptoms with different drugs to reduce inflammation and promote healing.
However, these are not cures and must be taken continuously to prevent relapse. The study found that the gut bacteria do not return to normal even when symptoms improve, which may cause relapses.
Because Crohn’s is mainly found in adults, most research has focused on them. However, UVA’s new findings provide important insights into Crohn’s in children.
The researchers believed that children with relapsing Crohn’s had ongoing inflammation and changes in their gut bacteria. These microbes are crucial for good health, and disruptions are suspected to contribute to disease.
Pierce, now a medical student at Georgetown, and her team compared gut biopsies from children with Crohn’s in remission to those from children without Crohn’s. They found significant differences: children with Crohn’s had fewer beneficial bacteria like Streptococcus and more harmful ones like Oribacterium. They also saw changes in immune cells, with increased CD4+ T cells essential for inflammation.
Interestingly, children with Crohn’s also had more substantial intestinal barriers. The researchers say this suggests that while current treatments are effective, they must fully address the disease’s root causes.
Even in children with Crohn’s in remission, researchers found ongoing microbial imbalances and slight inflammation. Current treatments focus on symptoms, leaving patients at risk of relapse. The research suggests that targeting the causes of these imbalances could lead to better treatments with fewer relapses.
This could result in improved treatments for both children and adults, such as using fecal transplants or tailored mixtures of healthy microbes to restore balance in the gut.
The study suggests that restoring average bacterial composition might help prevent relapses and potentially cure Crohn’s disease. Marie highlighted that the new findings were possible due to UVA’s collaborative culture.
Chelsea Marie, PhD, said, “Clinical research is vital for improving child health. Rebecca’s work united infectious disease, pediatric gastroenterology, and bioinformatics experts to address Crohn’s in our pediatric patients. We’re excited to continue this collaborative model.”
Understanding the microbiome to prevent, treat, and cure disease is a priority for UA’s TransUniversity Microbiome Initiative (TUMI), which unites researchers to advance this cutting-edge biomedical research.
Journal reference:
- Pierce, R., Jan, NJ., Kumar, P., et al. Persistent dysbiosis of duodenal microbiota in patients with controlled pediatric Crohn’s disease after resolution of inflammation. Scientific Reports. DOI: 10.1038/s41598-024-63299-y.