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People with Crohn's disease are typically treated with powerful anti-inflammatory medications that act throughout their body, not just in their digestive tract, creating the potential for unintended, and often serious, side effects.
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Crohn's disease develops from a chronic inflammation of the digestive tract, often the small intestine. More than half a million people in the U.S. live with this disease, which may require repeated surgeries to remove irreversibly damaged bowel tissue. Current treatments for this disease are powerful anti-inflammatory drugs that work in all parts of the body and cause often severe side effects. However, Sundrud's team found that immune effector T cells in the small intestine have developed a molecular sensing mechanism to protect themselves from the toxic effects of high bile acid concentrations.
These T cells use an entire network of genes to safely interact with bile acids in the small intestine. The MDR1 gene, known as ABCB1, is activated when a large subset of CD4+ T cells enter the small intestine. Then, the MDR1 gene acts in transient T cells to suppress bile acid toxicity and inflammation in the small intestine. This pathway sometimes works less well in some people with Crohn's disease.
Based on this discovery, Sundrud's team developed a therapy based on CAR T cells that act in the small intestine and promote MDR1 expression and also play a role in activating a IL-10 gene. The result in mice was a localized detoxification of bile acids and a reduction in inflammation.