Tiny implant could treat Crohn’s disease by sending small electrical pulses

October 25, 2016

Eight out of ten patients with Chrohn’s disease will end up needing surgery
A new treatment called vagus nerve stimulation could soon replace the op
The device has already proved useful in treating depression and epilepsy

Jane Feinmann for the Daily Mail

Published:
17:57 EST, 24 October 2016

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Updated:
18:45 EST, 24 October 2016

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A tiny electronic implant in the chest could soon be used to treat chronic bowel trouble.

The implant, roughly the size of a 50 p piece, emits small electrical pulses that fix faulty nerve signals going from the brain to the gut.

This treatment, vagus nerve stimulation, has been shown to inhibit the production of key inflammatory proteins thought to contribute to Crohn’s disease.

Crohn’s disease is a chronic inflammatory disease affecting the digestive tract and causing symptoms such as abdominal pain, diarrhoea and potentially dangerous weight loss.

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A tiny electronic implant in the chest could soon be used to treat chronic bowel trouble. It emits small electrical pulses that fix faulty nerve signals going from the brain to the gut

It is thought to be caused by the immune system going into overdrive and producing too much of a protein called TNF, which triggers inflammation.

Results from a recent trial by Dutch researchers suggest the implant is more effective than drug treatment and prevents the need for surgery.

At least 115,000 people in the UK have Crohn’s; eight out of ten patients will need a part of the intestine removed as it becomes so damaged it prevents digestion.

Conventional treatment is with drugs that suppress the immune system’s production of TNF.

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The problem is these drugs need to be given in hospital and can cause side-effects such as an increased vulnerability to infection, and they are often not very effective.

The new treatment targets one of the longest nerves in the body — the vagus nerve, which runs from the brain down to the abdomen — using an implant in the chest.

Vagus nerve stimulation is already used to treat epilepsy and depression, and given the nerve’s role in many bodily functions, the technique can be explored as a way of treating other conditions, from heart failure to rheumatoid arthritis, another inflammatory disease.

Crohn’s disease is a chronic inflammatory disease affecting the digestive tract and causing symptoms such as abdominal pain, diarrhoea and potentially dangerous weight loss

One study published in July suggested stimulating the vagus nerve can significantly improve symptoms of rheumatoid arthritis.

Importantly, the treatment led to an increase in the production of acetylcholine, a chemical which in turn reduced the ability of immune cells to produce inflammatory molecules such as TNF.

The device is fitted in an hour-long operation under general anaesthetic. A small incision is made in the chest and the device inserted under the skin. Wires from it are fed through to the neck to touch the vagus nerve.

CROHN’S MAY SOON BE TREATED WITH A VACCINE

Scientists at King’s College London are developing a vaccine to treat and possibly cure Crohn’s.

It’s based on the theory that a bacterium called MAP causes the disease, after studies showed the majority of patients carry MAP and animals infected with it show Crohn’s-like symptoms.

Scientists at King’s College London are developing a vaccine to treat and possibly cure Crohn’s

Healthy people may also carry MAP, but their immune systems kill it, whereas immune cells in Crohn’s patients may not be able to see it.

The vaccine reprograms patients’ immune cells to destroy cells containing MAP. The first human trials should begin in December at The Jenner Institute, Oxford.

If you are interested in joining the trial, go to jenner.ac.uk/volunteer.

Patients are then given a controller they can use to stimulate the nerve — this electrical stimulation is set at a frequency to which only the vagus nerve is sensitive.

Holding the controller to the implant for three minutes activates it — researchers say it feels like a mild muscle irritation.

In the latest study, presented at last week’s United European Gastroenterology Week in Vienna, six patients given the vagus nerve stimulators had a significant reduction in the number of ulcers in their gut and their levels of a protein called calprotectin — both signs of excessive inflammation in the gut.

Patients were able ‘to reduce or even end their reliance on medication,’ says lead researcher Dr Geert D’Haens, director of gastroenterology at the University of Amsterdam.

These were preliminary results of an ongoing 20-patient trial at four hospitals across Europe. Full results are expected next year.

A larger trial will then compare the efficacy of the treatment to a placebo. ‘That could lead to the device being approved for the treatment of Crohn’s,’ adds Dr D’Haens.

Adam Farmer, a consultant gastroenterologist at the Royal Stoke Hospital, says: ‘Despite robust animal and emerging clinical data, the exact role of vagal nerve stimulation remains to be fully determined, but it represents a novel area of research that has the potential to impact on patient care.’