Dr. Dunkin will review the state of TCM treatment and research with Crohn’s, EoE and other non-IgE mediated diseases.
David Dunkin is a pediatric gastroenterologist at Mount Sinai who works mainly with young patients suffering from inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis. These are immune-mediated diseases that share symptoms—abdominal pain, rectal bleeding, diarrhea, weight loss, fever, and joint, skin and eye involvement. In addition, when clinicians have trouble distinguishing between them, they use the term “indeterminate colitis” and “IBD undetermined” in referring to it. Dr. Dunkin says that Crohn’s children are often easy to spot because they are characteristically pale, thin, below average in growth, and malnourished all in the setting of the symptoms described above. Crohn’s disease affects 1.4 million Americans, 140,000 under the age of 18. Approximately 25% of all new cases in the population are under 20, and roughly 30,000 new patients are diagnosed annually. Remarkably, the incidence is increasing in the western world especially in children under 10 years old. Treatments include corticosteroids, enteral feeding—liquid diets fed through a tube into the nose—and monoclonal antibodies. They can have serious side effects, especially for child growth and development.
Dr. Dunkin treats patients in an IBD Center at Mount Sinai. A team approach includes adult and other pediatric GI specialists, nutritionists, surgeons, nurses and nurse practitioners, a social worker and two nutritionists. The center is also involved in clinical trials in some of which Dunkin is lead investigator.
Dr. Dunkin began working with Dr. Xiu-Min Li when she noticed that her food allergy herbal formula [FAHF-2] inhibited production of tumor necrosis factor alpha (TNF-a). High levels of TNF-a were also associated with Crohn’s disease. TNF-a increases the transport of white blood cells to inflamed sites where they spur the secretion of tissue-degrading enzymes, causing the damage that can be seen through endoscopy. High TNF-a levels are found both in the serum and the inflamed mucosa. Serum levels of the cytokine have been shown to align with clinical and laboratory indices of intestinal disease activity. Infliximab, a monoclonal antibody that inhibits secretion of TNF-a, is the first effective biological therapy approved for commercial use. Dr. Dunkin and his co-authors have written that monoclonal antibodies have “revolutionized” treatment of Crohn’s. However, he cautions that monoclonal antibodies have significant side effects and financial costs. For IBD, treatment involves lengthy infusions in hospital facilities at an annual cost of $30-40,000. “What we really need is a pill,” Dr. Dunkin says.
A survey at the IBD center at Sinai showed that most patients and parents were open to complementary and alternative treatments. Dunkin’s work with Li thus was conducted in a highly receptive environment.
Their first study showed that FAHF-2 has immuno-regulatory effects on human peripheral blood mononuclear cells (PBMCs) and mucosal tissue from Crohn’s subjects and in a murine model of colitis, affecting both the adaptive and innate immune systems. FAHF-2 inhibited TNF-a production by PBMCs and mucosa of CD subjects by both monocytes and T cells, suggesting that FAHF-2 targets pathogenic cells secreting in?ammatory cytokines. Besides targeting specific pathogenic cells producing TNF-a, FAHF-2 modulates many of the inflammatory cytokines shown to be elevated in CD. That suppression of IFN-a for Crohn’s patients is particularly interesting because among food allergy patients, it is too low and needs to be increased, which is exactly what happens when treated with FAHF-2, the same compound.
This indicated that FAHF-2’s immuno-modulatory effects vary depending upon the illness. Given the multiple effects, FAHF-2 may indeed be superior to single target medications like monoclonal antibodies and without the side effects seen with corticosteroids and other broad immuno-suppressants and monoclonal antibodies.
(This profile is adapted from Traditional Chinese Medicine, Western Science and the Fight Against Allergic Disease)