The Role of Exclusive Enteral Nutrition
Exclusive enteral nutrition (EEN) represents a pivotal strategy for managing Crohn’s disease, requiring patients to adhere to a strictly liquid diet for six to eight weeks, entirely omitting solid foods.
While the underlying reasons for the diet’s success were previously unclear, a recent study conducted by researchers at the Technical University of Munich (TUM) and the LMU University Hospital Munich has shed light on this topic.
Their insights are now driving a new clinical trial aimed at combining dietary approaches with fecal microbiome transfer, potentially enhancing treatment experiences for patients.
The EEN consists of a carefully designed liquid formula that incorporates a balanced assortment of vitamins, minerals, proteins, carbohydrates, and fatty acids, delivering all essential nutrients needed to manage the symptoms of Crohn’s disease effectively.
This dietary intervention is remarkable; patients often see symptom relief within days, bypassing the need for additional medical treatments.
Historically, EEN has been immensely effective, especially among children and adolescents.
This approach not only reduces inflammation but also encourages healing and growth of the intestines.
While adults also benefit from EEN, they often face the frustrating challenge of recurring symptoms within a year after treatment.
Innovative Strategies for Sustained Recovery
This brings up a crucial question: how can the positive effects of EEN be sustained over time? To tackle this challenge, Professor Dirk Haller, an expert in Nutrition and Immunology at TUM, and Tobias Schwerd, who oversees Pediatric Gastroenterology and Hepatology at Dr. von Hauner Children’s Hospital, have developed an innovative strategy.
Their work has uncovered the shifts in the gut microbiome—that complex community of microorganisms residing in our intestines—following dietary interventions and how these changes contribute to successful therapy.
Their research demonstrated that medium-chain fatty acids in the EEN not only bolster the growth of beneficial gut bacteria but also help to lower inflammation levels.
In experiments with an artificial intestinal model, they treated patient stool samples with the nutritional formula, successfully altering the microbiome.
When this adjusted microbiome was transplanted into mice, those animals remained free of inflammation.
Conversely, mice receiving an unaltered microbiome exhibited the usual inflammatory responses.
Future Directions in Clinical Trials
Now, the research team is poised to launch a clinical study to investigate whether these findings hold true in human patients.
The goal is to determine if a more robust and healthier microbiome can follow a “microbiome reboot,” thereby extending the duration of inflammation-free living for individuals with Crohn’s disease.
This study includes fecal microbiome transfer—often referred to as “fecal transplant”—which will occur after participants complete their dietary therapy.
In this phase of the trial, carefully screened healthy donors will provide their microbiomes, which will be encapsulated for patient consumption.
Maria J.G.T. Vehreschild, a professor with expertise in infectious diseases at the University Hospital of Cologne, is responsible for the processing of these capsules and is actively contributing to the study.
After undergoing dietary therapy, patients will ingest these capsules in hopes of further supporting their recovery.
Haller noted that fecal microbiome transfer has already yielded positive results in treating various gastrointestinal disorders, and there is optimism it might deliver similar results for those with Crohn’s disease.
According to Schwerd, the study will focus on three key aspects: assessing the safety and feasibility of fecal microbiome transfer post-diet therapy, and evaluating its potential to sustain disease remission or postpone flare-ups of inflammation.
If the team can achieve the cultivation of a healthier microbiome in patients over a prolonged period, it could mark a significant breakthrough in the ongoing fight against Crohn’s disease.
Source: ScienceDaily