14 ms·
First-in-human implantation of bionic device to halt Crohn's disease (2023)
- pazimzadeh 3y agoThis paper seems to describe the general strategy: Neuronal regulation of the gut immune system and neuromodulation for treating inflammatory bowel disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565205/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565205/ It would be incredible if it works, since it would avoid treatment with systemic immunosuppresives which can promote infection/cancer. However maybe there is still a local risk of the above? I would also be concerned about the implant getting covered in nasty biofilms over time. If this type of thing works, does that mean that medication that target the nerves might work against inflammatory disease?
- yosito 3y agoI think most of these claims are BS, but I've met several people who have claimed to heal their own inflammatory diseases through non-medical practice to help regulate their vagus nerve. I know for me, these types of practices seem to help manage my symptoms. So maybe there is some connection.
- pazimzadeh 3y agoWhat claims are BS. What did your friends do wrt their vagal nerve
- epgui 3y agoThat’s wishful thinking. Please don’t go off your IBD meds or you will regret it some day.
- deleted 3y ago[deleted]
- fao_ 3y agoThe vagus nerve sits inside the collarbone right next to the carotid artery. As a doctor told me once, if you're able to physically stimulate your vagus nerve, you need to get to A&E posthaste, lol
- jdadj 3y agoLook up vagal maneuvers. Used by a subset of tachycardia patients to reset to a typical heartbeat. https://en.m.wikipedia.org/wiki/Vagal_maneuver https://en.m.wikipedia.org/wiki/Vagal_maneuver
- hanniabu 3y agoWhat's A&E? Googling only shows the cable network
- firejake308 3y agoAccidents & Emergency is what the Brits call the Emergency Room
- JohnVideogames 3y ago"Accident & Emergency" - you may know it as the Emergency Room, but it's commonly called A&E in the UK
- astura 3y agoBritish for "emergency room."
- xtracto 3y agoIIRC there's a stage 2 Test device that uses vagus nerve stimulation through the tongue to attenuate tinnitus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120162/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120162/ I think it's called the Susan Shore device, and nowadays is the main hope for curing tinnitus to some degree.
- firejake308 3y agoThat makes more sense for IBS (irritable bowel syndrome) than it does for IBD (inflammatory bowel disease). IBS is caused by the gut-brain nervous system acting up due to stress, and vagal maneuvers forcibly turn off the fight-or-flight response from the nervous system. On the other hand, IBD is caused by your immune system attacking itself in the gut, and the T cells aren't really connected to the nervous system in any physiologically relevant way. So your friends were probably talking about IBS, not IBD.
- cachecrab 3y agoVagus nerve stimulation can help IBD > The vagus nerve regulates inflammation and cytokine release through the inflammatory reflex. Recent pilot clinical trials using implantable bioelectronic devices have demonstrated the efficacy of vagus nerve stimulation (VNS) in adult patients with inflammatory bowel diseases (IBD) as an alternative to drug treatments. https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-023-00129-y https://bioelecmed.biomedcentral.com/articles/10.1186/s42234...
- JR1427 3y agoThere could still be a link between the nervous system and IBD, too. When I was diagnosed with UC, the inflammation perfectly correlated with a portion of the colon that was connected to a particular nerve (I can remember which - it was a few years ago by now). I dismissed it as BS at the time, but a physiologist once asked me where I feel the physical sensation when I am stressed or anxious, and I said my gut. He thought that was very interesting (since I had recently been diagnosed with UC). I thought nothing of it, but maybe there is a link. (My wife, in contrast, feels anxiety and stress as a feeling in her chest.) More and more, scientific research is pointing towards how all the systems in the body are connected one way or another, so I wouldn't be at all surprised if there is also a link between IBD and the nervous system.
- trebligdivad 3y ago> I would also be concerned about the implant getting covered in nasty biofilms over time. The implant doesn't necessarily sit inside the gut though does it ? Just somewhere it can ping the relevant nerve.
- pazimzadeh 3y agoI don't have the citation for this, but I learned in a class long ago that most implanted devices end up covered in biofilms, it's only a matter of time. Especially if it's plastic. e.g. breast implants, catheters, etc.
- epgui 3y agoI highly doubt that this would obviate the need for biologics, but I think it would probably work very well in combination.
- atombender 3y ago> can promote infection/cancer Note that while TNF inhibitors like adalimumab (Humira) have a black box cancer warning in the US, this was based on assessing a small number of studies early on. We now have more than 20 years of studies and patient registry data, and later studies, including meta-analyses, have concluded that there is no additional risk of cancer with these TNF inhibitors. E.g. see: https://pubmed.ncbi.nlm.nih.gov/24361468/ https://pubmed.ncbi.nlm.nih.gov/24361468/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770105/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770105/
- spenrose 3y agoA co-author of the first study is employed by Humira's maker; the second study was funded by it. Doesn't mean they are wrong, but it does suggest some skepticism is due.
- atombender 3y agoThose were only the first two studies that came up on PubMed. There are a number of studies that support the same conclusions.
- pazimzadeh 3y agoYes but that's one drug, which does increase your risk of infection according to your links. There are other newer drugs for which we don't have 20 years of data. The best thing is if we could target these drugs to only be activated in areas of active inflammation.
- atombender 3y agoYes, we have less data on newer drugs, but TNF inhibitors are currently the go-to medication for many autoimmune disorders, including Crohn's and UC. Infection risk is currently the case with all current medications that act on the immune system. In all cases we are merely suppressing some pathway where the end goal is to reduce the immune response. ThatMs really the best we can do until we actually identify the causes, and can address that rather than "dialing down" our immune systems.
- NotGMan 3y ago[flagged]
- ctrw 3y agoAnecdotes aren't data. Cornhs disease is know to go into sponteneuous remission in around 10% of patients for no reason what so ever for years to dacades at a time. So if you have batch of a thousand people each going from one fad diet to the next you'd get around 100 of them telling you very loudly that whatever flavour of the month cured them. The 900 who didn't just move to the next fad.
- EdwardDiego 3y agoMy two half-brothers have Crohn's. My step-sister's two boys have Crohn's. I don't have Crohn's. She doesn't have Crohn's. There's research ongoing into the genetics of Crohn's. Changing diet can help ameliorate the symptoms, but it won't cure it any better than "taking the air" in Switzerland will cure asthma. And stating so boldly that a "wrong diet" causes it? Just to reiterate, of five kids raised on the same diet, (me, my 2 half-brothers, my 2 step-siblings) two have it, three don't. But sure, just eat some raw meat or drink some vegan juice, problem solved... ...are you actually fucking serious mate? You obviously know nothing about Crohn's and your glib handwavey internet opinion of "Duh, just eat some meat and roots" is, well, so goddamn dumb and shallow it's actually offensive. Wovon man nicht sprechen kann, darüber muss man schweigen. Whereof one cannot speak, thereof one must be silent.
- NotGMan 3y ago[flagged]
- spondylosaurus 3y agoCrohn's has very strong genetic links, so anyone blaming it on diet is very silly :P I'm guessing your half-brothers and half-sister's kids have the HLA-B27 gene, which is the big one for autoinflammatory diseases.
- 3y ago
- roschdal 3y ago[flagged]
- pas 3y agoI will just call my assistant to get the jet and shack ready in the Hamptons, and to cancel all my meetings!
- roschdal 3y agoThis is a logical fallacy argument where you exaggerate. What I describe can be done in most locations, no Hamptons needed.
- Elinvynia 3y agoFor most people work is equal to stress. They need to work to have money to live. Unless you are willing to pay for this person's existence, it is rude to suggest to "just have less stress", essentially equal to victim blaming.
- EdwardDiego 3y agoNo, it won't. This is so stupid.
- Snoddas 3y agoquantify enough
- cco 3y ago
- rgmerk 3y agoI have Crohn’s but am one of the lucky 20% who is in long-term remission without surgery and without the more problematic drug therapies - thus far! But if this works as well as hoped it will bring a lot of peace of mind that if I do ever need surgery, I won’t be going back in for more every few years. Medical research is awesome, for all its inefficiencies.
- epgui 3y agoWhich drugs are you talking about? Pretty much all the biologics for CD have amazingly positive safety profiles…
- 6177c40f 3y agoAll of them increase risk of cancer (EDIT: upon further review, maybe not all of them? Or maybe just with combination therapy?) and severe infection. Many of the biologics are also quite new, and the long term effects of taking them are not well understood. Plus, in some cases they don't work well enough alone and so multiple drugs are required (a biologic in combination with something like methotrexate or azathioprine is typical), which further increases risks. Anecdotally, I know of a couple people who had bizarre and severe immune reactions to biologics that left doctors baffled, so that's something that can also occur, apparently. Also some people are just prescribed steroids like prednisone for whatever reason, which has some pretty negative long term effects.
- jessriedel 3y agoAt least for Ulcerative Colitis, there are safe drugs that are much less effective (mesalamine) but the strong effective drugs all come with long-term cancer risks (prednisone, remicaid, entyvio, etc), as you say. The newer drugs like entyvio are generally less risky than the older ones, mostly on account of being more targeted, but the risk is still significant. I imagine the situation is similar for CD.
- 0x00_NULL 3y ago
- cjdell 3y agoI initially wrote this as a reply to a comment by "NotGMan" mentioning fasting/paleo that got flagged. They could have approached the subject more delicately but I believe they have a point. About 3 years ago I had gut issues so bad I thought I was close to death. NHS couldn't see any problems and were basically telling me I'd gone nuts. They refused to do any further testing. After a year of suffering I tried a 7 day water-only fast and the pain finally went away. I broke fast with only paleo foods and stayed that way for 6 months. I gradually introduced other foods after that period with the last being gluten about 2 years after the initial fast. I am almost cured, however I will never abuse my gut in the same way again. Less carbs, more salads... This is just my personal experience of course but I have discovered so many other people with similar gut issues who are also being ignored by their doctors that you can't blame one for wondering if there is a conspiracy at play. I wouldn't have believed any of this a few years ago but now I have serious doubts in modern medicine's ability to deal with chronic health issues, especially in the gut. We do eat so many more processed foods (and other things) that it doesn't require that much of a stretch to the imagination that diet is a part of the problem or indeed the root cause. Lack of openmindedness bothers me immensely and the nature of human biology is under no obligation to fit into tidy boxes for the sake of our understanding. The real world is fuzzy.
- Buttons840 3y agoDecades ago, about 30% of the people who had celiac disease would waste away and die, especially children. Until a doctor noticed that if the people ate 12 bananas a day they seemed to do better. Of course, 12 bananas a day is a kooky diet, but people who eat 12 bananas a day tend to eat less of everything else, including less bread and gluten and so they would do better. Later science figured out bread was a problem and then eventually identified the specific protein (gluten) that effects people with celiac disease. I think there are other foods that bother different people, but we haven't managed pin down exactly which foods bother which people. It's a hard problem, but surely there are other cases of "if you just avoid this specific food ingredient, you will recover", just like celiac disease. So, on the one hand, sharing advice about which diets worked and didn't work can be helpful (like the 12 bananas a day diet). On the other hand, "I tried an unusual diet, which also happens to have a good amount of marketing behind it, and things are better" is one of the most common bits of advice you'll find for many diseases, and the problem is everyone recommends a different diet. A relative of mine has Chrons disease and was close to death before it was diagnosed, the doctors recommended a junk food diet basically, high calorie foods with almost no fiber, and that's how he eats now and is doing much better. I don't recommend everyone follow the same diet, but for whatever it's worth, eating junk food has helped my relative, true story. And this is what I mean, there's so much conflicting advice about which diet to try. I can't fault people for trying different diets, because I believe there are many unknown disease, like celiac disease, which can be treated with an exact (but as of yet unknown) diet. I also don't fault people for giving up and not enthusiastically trying every diet-of-the-week that gets suggested, it's tiring. Also, it's notable that the diets with the most marketing tend to be the ones most recommended.
- deleted 3y ago[deleted]
- lebuffon 3y agoWe have so many "bandaids" but very few cures these days. Perhaps AI systems will allow us to find root causes of these insidious diseases.
- munificent 3y agoWe have so many cures that we simply forget about many diseases entirely.
- jjk166 3y agoDepending on how they are counted there are between 10000 and 70,000 different human diseases, and treatments only exist for around 500 of them. Further, the overwhelming majority of these treatments are not cures, i.e. treatments that end medical conditions in an individual.
- xtracto 3y agoReminds me of GERD. It's a disease that affects a sizable group of people. It's a mechanical issue that is very well studied and known. Yet, the main two treatment options are "workaround/hacks" or a very invasive operation. There's only one [1] potential nobel "curing" treatment which is just gaining traction. But innmy opinion with current technology, stuff like GERD or chronic bowel incontinence (due to mechanical failure of anjs sphincter) should be 100% solved. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624249/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624249/
- spondylosaurus 3y agoI mean, we have a pretty decent understanding of the causes and mechanisms behind Crohn's and colitis. The problem is that "your immune system is going nuts" is a hard problem to solve once it gets started, and the human immune system loves to go nuts on a moment's notice.
- wholinator2 3y agoGenuinely asking, do we? Like, we might understand the mechanism but do we actually understand the cause, the "why" behind the mechanism? It was my understanding that there's practically infinite variety in which foods cause symptoms for different people, and that the specifics of each were still largely unknown
- hardware2win 3y agoIs Crohn getting more and more common recently?
- Khelavaster 3y agoThis is NOT to halt chrohn's disease. This is to reduce side effects from primitive colon-removal surgery to treat Crohn'# symptoms.
- ibash 3y agoThat’s not my reading. One of the main symptoms of crohns is inflammation that leads to scarring and then surgery to remove the scarred intestine. If this stops inflammation/ scarring that’s a big part of it. Or to put it another way: you get scarring before surgery, too. The problem is that overtime there’s only so much intestine you can remove.
- hinkley 3y ago> Australia has among the highest incidence of Crohn’s disease in the world We really need to look at supply chain and environmental factors.
- Centigonal 3y agoIBDs like Crohn's and Ulcerative Colitis have increased in incidence (controlling for better diagnosis) as countries develop[1] [2]. People in developing countries have a lower rate of incidence, and if they move to developed countries, the incidence remains low. However, their children, born in developed countries, experience the higher rate of incidence. Something about being a child in a developed country increases your chance of developing an IBD Several theories have been proposed, including hygiene hypothesis, lack of fiber in the diet, and pollution, but finding causality has been hard. Worse yet, nobody knows what causes these illnesses. It's also interesting to note many food allergies have increased in prevalence in the last 30 years - although the causes for that might be different, they are both GI related auto-immune conditions. [1] https://www.gastrojournal.org/article/S0016-5085%2811%2900164-8/pdf https://www.gastrojournal.org/article/S0016-5085%2811%290016... [2] https://www.thelancet.com/cms/attachment/1bc07ee3-782c-4670-bcad-70e92c563d9e/gr1.jpg https://www.thelancet.com/cms/attachment/1bc07ee3-782c-4670-... [3] https://pubmed.ncbi.nlm.nih.gov/19917585/ https://pubmed.ncbi.nlm.nih.gov/19917585/
- 1letterunixname 3y agoI worked with someone at big name university biomedical informatics department who found out only in their early 30's by emergency health crisis that they had Crohn's. Perhaps with some people it requires an emergency for there to be clinical investigation, or epigenetic conditions silence some pathologies until there is a specific stressor or gene activation. I sure hope a CRISPR edit treatment comes along to permanently cure some of the serious Crohn subtypes.