IBD research

IBD research


(upbeat music) – Well, if you think about it, the way that humans evolved was to live in a very
different environment, a much dirtier environment where food was much scarcer and the quality and
the cleanliness of food was very different and the rates of infectious diseases was much, much higher. So the immune system was basically evolved to deal with that, cope with that, but in 100 years, we’ve transformed that. So we’ve taken bacteria like H pylori that used to live in everybody’s stomach out of the question. We’ve taken worms out of the intestine. We’ve cleaned up our food. We’ve cleaned up our water supply. We’ve largely eradicated a lot of early childhood infectious diseases through immunisation programmes and that’s brought a lot of good. But our immune system hasn’t caught up and so we’ve seen a rise in what we call autoimmune conditions and
auto-inflammatory conditions, some things which people are much more kind of aware of perhaps,
like asthma and eczema, but Crohn’s disease, also ulcerative colitis, and inflammatory bowel disease, which sits somewhere in that same spectrum of this mismatch between
what the immune system is basically built to do and what it’s actually being asked to do and I think that’s the
main thing that’s led to this rise in inflammatory bowel disease in recent decades. (upbeat music) So the more common a condition is the more clinicians see of it, the more it’s in their thoughts and the more questions are raised by that. So if you see 100 children with
inflammatory bowel disease, there’ll be two or three who
are unusual or atypical who don’t respond to the treatments that you might expect them to do and so that raises questions
in the clinician’s mind. Plus if you’re an inquisitive person and the things that are
coming through your door, you’ll start to ask
questions about why is this, what’s going on, and what can I do better than what’s already available. And so, this inquisitive
nature, and with a bit of time which is obviously a major
commodity and a real problem for a lot of people, leads to people pursuing
research questions and doing research and that’s where a lot of that has come in inflammatory bowel disease. I mean, what I would say about research is a lot of it is observational where we’re trying to count cases, describe what we’re seeing,
describe what happens in terms of the disease history in cases, and that’s very important work but also, of course, we
need to be thinking about new therapies and how we develop them, how we test them, and how
we understand how they work so that we can further refine them and make them even better going forward. So that’s hopefully where
research is going to go soon. (upbeat music) So a lot of my research is
about the gut microbiome so the bacteria, fungi, and viruses that naturally live with
us within our gut ecosystem and contribute to our state of wellbeing and our tools for exploring and describing the microbiome have been
transformed in the last decade which has led to a real revolution in first describing what happens
and what’s going on there but now, increasingly,
looking at how it changes and how it’s modified by therapy and starting to think about how we might use different therapies to address it directly. So, I’ll give you two examples of that that I’m involved in. One of them is in dietary
therapies for Crohn’s disease. So, in Glasgow, we’ve developed this thing called the CD-TREAT diet which is Crohn’s disease
treatment with eating and it looks to treat Crohn’s disease by giving people a very selective diet that is based around what we know already from exclusive enteral nutrition, a very successful treatment
for treating Crohn’s disease. But exploring how that
addresses the gut microbiome so that we can understand how it works and then refine it and make it better. Second example for our sort of clients would be this idea of fecal transplants which perhaps sounds a
little bit disgusting, a little bit off-putting to begin with but this is taking someone
else’s gut microbial community, someone’s else microbiome, and transplanting that into another person with an idea of trying
to help and alleviate and improve their disease and most of the studies about this have been in adults so far with fairly limited but
quite encouraging results and what I would always say about that is that we need to use that
as a baseline to build on to say, okay, what do we
understand about these results, these people who have succeeded
and had a good response, and what is it doing to them as a kind of marker of
what that’s telling us about the disease, so that, again, we can refine that, make it better, and make it an improved
and more tolerable therapy and move away from a kind
of, basically a crude thing, which is someone else’s poo into more refined if
we give these bacteria and these populations to this person and they’re likely to respond to that. So that’s the whole area, I suppose, of what I would call
microbial therapeutics which is addressing the microbiome directly with therapies for IBD. (upbeat music) So I suppose my big ambition for inflammatory bowel disease would be to move us
further and further away from drugs that suppress the immune system and towards more clever therapies that directly deal with
the causes of the disease and are perhaps less,
have less side effects as a result of that. So, for instance, more
nutritional therapies, more microbial therapies, and less of these drugs that
suppress the immune system and that’s not to say that these drugs don’t have an important role. I use them every day in my practice and they transform people’s lives and they will continue to do so for many decades to come, that no one’s saying that
they’re not gonna play a role but having different avenues to explore and perhaps, particularly
avenues to explore at the beginning of disease when things might be more malleable – we’re not absolutely sure about that. Some people think that
earlier in the journey you might be able to change
things in a different way that set off the disease course and make it less problematic and also, once you’ve got
people into remission, in terms of trying to keep them there and make them less
dependent on medications to keep them there. So I think that’s probably
going to be the biggest change or the biggest development within inflammatory bowel
disease research and treatment in the coming decades and,
perhaps, two or three decades. (upbeat music)

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