A North American team of researchers, co-lead by a Western professor, hopes their work will ultimately lead to treatments that reduce infections, pain, and hospitalizations for millions of Crohn’s disease sufferers around the world.
Along with colleagues at the Cleveland Clinic and Mayo Clinic, Schulich School of Medicine & Dentistry professor Dr. Brian Feagan will co-lead the Stenosis Therapy and Anti-Fibrotic Research (STAR) consortium. This team will develop imaging and patient-reported tools to better understand the effectiveness of new anti-fibrotic therapies for Crohn’s disease.
The initiative is supported by $4.3 million in funding from the Leona M. and Harry B. Helmsley Charitable Trust.
“The traditional treatments for Crohn’s disease have been based on reducing inflammation. But if you don’t know the cause for a given disease, you’re really treating the process you understand – the inflammation,” explained Feagan, a Robarts Research Institute scientist. “That works relatively well. But the idea is to prevent fibrosis from occurring. It’s a bit of a tall order.
“This is the next frontier – we are going beyond inflammation and treating the processes leading to bowel narrowing. Ultimately, the goal is to identify treatments. But before you can do that, you have to have the measurement tools.”
People with Crohn’s disease, a chronic inflammatory condition of the bowel, experience disruptions to the body’s ability to digest food and absorb nutrition, leading to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.
Frequently, Crohn’s patients develop a narrowing of the intestinal tract due to the formation of excessive scar tissue, known as fibrosis. The development of anti-fibrotic drugs, therefore, could mean greatly reducing infections, pain, surgeries and hospitalizations that currently result from disease complications.
“Crohn’s involves all the layers of the bowel wall; it’s not just superficial, unlike ulcerative colitis, which involves just the colon,” said Feagan, noting Canada has among the highest incidence of Crohn’s disease in the world.
“Crohn’s can affect any part of the GI (gastrointestinal) tract. So when it does, the body’s normal reaction to the inflammation is to form scar tissue. When that occurs, the lumen of the bowel – the area that is really the inner chamber of the bowel – closes down and it blocks. You’re left with having to have surgery to be relieved of blockage.”
Although advances have been made in the treatment of inflammation, the development of treatments for Crohn’s disease fibrosis has been hindered due to a lack of appropriate tools that enable clinical testing of anti-fibrotic drugs.
The new consortium will draw upon the expertise of each of the centres to develop a radiological index, using MRI techniques, to measure fibrosis in the bowel and how they respond to anti-fibrotic therapies, as well as develop a specific index that measures symptoms experienced by stricturing Crohn’s disease patients, related to bowel narrowing.
Feagan said there has been progress in treating fibrosis in other diseases, such as liver disease, and he is hoping to apply similar strategies for Crohn’s disease.
“We have to take a different approach to measure this with Crohn’s. This funding will allow us to build the tools we need, allowing us to study fibrosis prevention strategies,” he said. “There has not been any specific anti-fibrotic strategies and treatments available for Crohn’s based on existing measurement and approaches we have.”