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The intestines make up the largest immune organ in the body , explains Edwin de Zoeten , MD , PhD , pediatric gastroenterologist at Children ’ s Hospital Colorado . When it functions properly , the intestines recognize harmful bacteria and attack them appropriately , returning to a calm state after the bad bacteria are wiped out .
For patients who have Inflammatory Bowel Disease ( IBD ), which includes Crohn ’ s disease and ulcerative colitis , though , the intestines can be overzealous against harmful bacteria , and end up attacking good bacteria , throwing the microbiome out of balance and perpetuating inflammation of the intestines .
Dr . de Zoeten ’ s goal is to figure out how to help patients with IBD regain balance , or homeostasis , through his research . Currently , most IBD treatments try to do that through medications that suppress the inflammation , but Dr . de Zoeten is dissatisfied with their side effects .
Instead , he has come to believe in nutritional therapy , a standard of care in Europe and Britain . But because it can be an uncomfortable treatment for some patients , Dr . de Zoeten says , only select other pediatric hospitals in the U . S . use it regularly for kids with Crohn ’ s disease .
Nutritional therapy requires a patient to receive more than 90 percent of their food through a soft naso-gastric tube for three months or longer . The tube can initially be uncomfortable to place and the patient has to refrain from eating most foods during that time . Culturally and behaviorally , that can be a huge challenge for kids and families .
But it ’ s hard to ignore the results of this therapy : Up to 80 percent of Dr . de Zoeten ’ s patients who undergo nutritional therapy as soon as they ’ re diagnosed with IBD go into remission after three months .
Though patients don ’ t always stay in remission , it ’ s nevertheless an unprecedented success rate among IBD therapies and reduces the need for high doses of medicines that may have unwanted side effects .
“ Overall , much of our work goes into trying to convince the body to return to homeostasis , and nutritional therapies will likely play a major role in the future treatment of IBD and regaining this balance ,” Dr . de Zoeten says .
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Lactoferrin
Dr . de Zoeten and his team are also conducting basic research on this protein in breast milk that activates cells that calm the immune system . When they fed mice lactoferrin , it activated their regulatory T-cells , which calmed the immune system . Dr . de Zoeten is partnering with a company that isolates lactoferrin from rice to make large quantities for patient use .
Heat Shock Pathway and Unfolded Protein Response
At the molecular level , Dr . de Zoeten is studying two pathways that are known to affect balance in the intestine : the heat shock pathway ( which activates when you have a fever and calms inflammation ) and the unfolded protein response . So far , they have found that if you activate the heat shock pathway , it stimulates the regulatory T-cells .
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GASTROENTEROLOGY & GI SURGERY
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