Gastroenterology | Mount Sinai Today

Pioneering Discoveries in Inflammatory Bowel Disease

Nov 5, 2019 | Featured, Gastroenterology, Research

Precise cell types that correlate with a patient’s resistance to the standard therapy for Crohn’s disease—anti-inflammatory drugs called TNF inhibitors—have been identified for the first time by researchers at the Icahn School of Medicine at Mount Sinai and published in the September 5, 2019, issue of Cell. TNF inhibitors are used in Crohn’s disease to stop inflammation, but as many as 30 percent of patients do not respond to this treatment and require surgical intervention within 10 years after diagnosis. The new discovery could open the door to identifying biomarkers and tailoring better therapeutic options for these patients.

At the same time, two studies in the September 26, 2019, issue of The New England Journal of Medicine validate effective therapies for patients with treatment-resistant ulcerative colitis (UC), a chronic inflammatory disease of the large intestine. Both of these studies were led by Bruce E. Sands, MD, the Dr. Burrill B. Crohn Professor of Medicine and Chief of the Dr. Henry D. Janowitz Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai.

The results of Dr. Sands’ first clinical trial validated ustekinumab as a UC therapy. In the phase lll clinical trial, Dr. Sands and his team tested more than 900 patients with moderate-to-severe UC who were unable to tolerate or had an inadequate response to TNF inhibitors. The results from this trial led the U.S. Food and Drug Administration in October to approve ustekinumab for adult patients with moderately to severely active ulcerative colitis. Ustekinumab had previously been approved for treating patients with Crohn’s disease.

The second study was the first ever head-to-head comparison of two biologic therapies for inflammatory bowel disease: vedolizumab and adalimumab. In total, 769 participants with moderate to severe UC were recruited for this randomized phase 3b study, with 383 patients receiving 300 mg of vedolizumab intravenously at weeks 0, 2, and 6, then every 8 weeks, and with subcutaneous placebo injections, and 386 receiving placebo intravenously and adalimumab subcutaneously (160 mg week 1, 80 mg week 2, and then 40 mg every 2 weeks).

Researchers found that patients who received vedolizumab achieved significantly higher week 52 clinical remission rates than patients who received adalimumab (31.3% versus 22.5%) and endoscopic improvement (39.7% versus 27.7%). The remission rates for both therapies were similar among the 20% of participants who had previous exposure to TNF inhibitors.

In the study in Cell, Mount Sinai researchers used single-cell RNA sequencing and CyTOF technology to examine inflamed and noninflamed small intestine tissue samples as soon as they were removed from Crohn’s disease patients. Looking at the lesions in real time on a single-cell level, the investigators identified the immune cells and the circulating blood cells and their interactions, and mapped a landscape of thousands of cells in the lesion.

“Single-cell profiling provides unprecedented information on the make-up of the disease,” says co-corresponding author Miriam Merad, MD, PhD, Director of the Precision Immunology Institute and the Human Immune Monitoring Center at the Icahn School of Medicine at Mount Sinai. “This type of analysis will help us understand why patients respond to or resist specific treatment and what else we could
be targeting.”

Co-corresponding author Judy H. Cho, MD, Director of The Charles Bronfman Institute for Personalized Medicine, and Ward-Coleman Professor of Translational Genetics and Medicine at the Icahn School of Medicine at Mount Sinai, says, “We designed this study in a way that defines inflammation with unprecedented precision using immunology and computational biology to get a better understanding of this disease.”

Computational biologist Ephraim Kenigsberg, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai, and co-corresponding author of the Cell study, says, “Single-cell analysis revealed different cellular signatures, and when we integrated this with larger data sets, including clinical trials, we were able to make our findings clinically relevant.”

National Recognition for Excellence In Inflammatory Bowel Disease

Updated on Jun 30, 2022 | Community, Gastroenterology

Jean-Frédéric Colombel, MD, whose research has led to some of the most seminal discoveries in Crohn’s disease and ulcerative colitis—chronic inflammatory conditions that damage the gastrointestinal tract—was one of three national recipients of the 2018 Sherman Prize. The award, which recognizes individuals for pioneering achievements that have significantly transformed patient care, was presented by the Bruce and Cynthia Sherman Charitable Foundation at the Advances in Inflammatory Diseases conference Thursday, December 13, in Orlando, Florida.

Dr. Colombel, Director of The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai, was lauded for his highly collaborative work bringing together geneticists, microbiologists, epidemiologists, systems engineers, and clinicians to study new concepts in the causes, prognosis, diagnosis, and treatment of inflammatory bowel diseases. He also was honored for mentoring and motivating the next generation of physician scientists.

Said Dr. Colombel: “It’s a long and difficult road ahead, and it will require great collaboration among the world’s top scientists and researchers, but I think we will be able, in the near future, to predict the onset of Crohn’s disease before the first symptom appears, which creates the possibility for one of medicine’s primary aims—preventing disease.”

Jean-Frédéric Colombel, MD, left, with Bruce Sherman

Building Awareness of Colorectal Cancer

Updated on Jun 30, 2022 | Community, Gastroenterology

The Rollin’ Colon, a 30-foot-wide inflatable model of a colon, was on display in Guggenheim Pavilion on Wednesday, March 7, during Colorectal Cancer Awareness Month—the highlight of a community health fair that was organized by nurses at The Mount Sinai Hospital Endoscopy Center. Sponsored by the Endoscopy Center in partnership with the Colon Cancer Challenge Foundation, the walk-through model allowed visitors to see visual representations of common colon cancer symptoms. Mount Sinai physicians, nurses, pharmacists, and staff also distributed literature, answered questions, encouraged visitors to be screened, and handed out small prizes to attendees who correctly answered colorectal health-related questions.

Representatives from Epicured, a company that delivers healthy food for patients with gastrointestinal issues, displayed their products at the fair.

Pulses

Updated on Jun 30, 2022 | Aspen Ideas 2016, Diet and Nutrition, Gastroenterology, Health Tips

Guest post by Jennifer Ross, MS, RD, CDN, a Clinical Nutritionist at Mount Sinai Beth Israel.

Lately I’ve been hearing a lot about pulses – that they’re the new “it” food of 2016. I’ve heard that they provide ample health benefits and are replacing things like quinoa, kale, and other exotic-sounding foods (that are bound to be hard to find and expensive) as the new life-changing power food. The word itself is ugly, and reminds me of a beating heart, and something that I definitely do not want to eat. I will be the first to admit that I actually had no idea what a pulse is. Have you heard of them? I was pleasantly surprised to learn what pulses actually are, and to find that I’ve actually been eating them fairly regularly throughout my entire adult life. (more…)

Video Blog: Colorectal Cancer Awareness Month

Mar 12, 2015 | Cancer, Gastroenterology, Health Tips

Guest post by Gina Sam, MD, MPH, Director of the Gastrointestinal Motility Center at The Mount Sinai Hospital

In the United States, colorectal cancer, or colon cancer, is the third most common cancer in both men and women and is the second leading cancer killer among Americans. Colorectal cancer affects both men and women and is often found in people age of 50 or older. It is considered a preventable disease and if it is detected early enough it is treatable, which is why routine colonoscopies help lower your risk of developing colorectal cancer. (more…)

Why Do I Get a Sore Throat When I Exercise?

Updated on Jun 30, 2022 | Ear Nose Throat, Exercise, Gastroenterology

Two main causes of sore throats during exercise are nasal obstruction and acid reflux.

Poor Airflow Through the Nose

Poor flow of air through the nose makes it harder to get enough oxygen, especially during a workout. We are inclined to open our mouths to breathe better, especially when we are out of shape. And many of us who are in shape find it more comfortable to breathe through the mouth, particularly when the nose is not working properly. Mouth breathing, however, can dry out the throat, causing it to feel irritated and sore for some people. We are born as obligate nose breathers, meaning our bodies physiologically prefer breathing through the nose. While the mouth is meant for eating and talking, the nose is meant for breathing; it is our air filter and air moisturizer. Therefore, when possible, it is best to breathe through the nose while exercising.

‘Silent’ Acid Reflux

Chronic acid reflux that we are not aware of—also known as silent reflux—can cause sore throats, hoarseness, and throat clearing. Working out soon after eating, before you digest your food, can allow acid into the back of the throat as you jump up and down, causing throat pain. Many of us make thick mucus that coats the throat and protects it from the acid, but some of us don’t have enough, and our throats get sore as a result. To prevent exercise-induced sore throat from acid reflux, try waiting to work out until three hours after eating, and cut down on highly acidic foods. If that is not enough, you can try an over-the-counter acid reflux pill one hour prior to exercise. Then if still not improving, see your doctor.

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