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Exploradio brings you captivating stories about science worth discovering and examines powerful questions worth answering.

Exploradio: Cleveland Researchers Look for New Ways to Treat the Incurable Crohn's Disease

photo of mahmood ghannoum
Mahmoud Ghannoum is a pioneer in the study of the human mycobiome, a term to describe fungus living in our body. He's developed a line of probiotics to promote a healthy gut and published a book, "Total Gut Balance."

There is an ecosystem living inside of us that scientists are only beginning to comprehend.

Our microbiome aids in digestion and metabolism, but when out of whack, can cause discomfort, disease… even depression.

In this week’s Exploradio, we meet researchers in Cleveland who are working toward a better understanding of how to have a happy gut.

We’ve gone to see Dr. Fabio Cominelli, who's unapologetic about the state of his lab.

“Good labs are messy," Cominelli said. "It means they do a lot of work.”

As head of gastroenterology at University Hospitals and head scientist at UH’s Digestive Health Research Institute, he is producing a lot of work.

One project is studying the bacteria involved in Crohn's Disease, a type of inflammatory bowel disease that affects more than 1.6 million Americans.

We meet research assistant Mathew Conger who's growing gut bacteria for testing, which, it turns out, is not that easy.

That's because after evolving for a life in our gut, these microbes can’t be around oxygen.

“So if they even get a whiff of it," Conger said, "it will either kill them or slow their growth.” 

Neither is good for the experiment Cominelli is doing.

He is currently testing around 20 strains of bacteria taken from Crohn's patients, “and we transfer those in the mice to find out if we can reproduce the disease in our mice.” Some may be culprits, some are innocent bystanders.

His work is even more urgent because Crohn's and the related disorder ulcerative colitis are emerging as a world-wide epidemic.

The search for a cause
Inflammatory bowel disease, or IBD, is a devastating condition that has no real cure and no known cause.

fabio cominelli
Dr. Fabio Cominelli is head of gastroenterology at University Hospitals and head scientist at UH's Digestive Health Research Institute.

IBD is generally a disease of the developed world. Genes and antibiotic use are factors, says Cominelli, but he also thinks the increasing rates of Crohn’s and colitis has more to do with the modern diet.

“The way we process food with food additives, the use of artificial sweeteners, artificial components in our food,” all are a concern he says. A recent study showed that using Splenda doubled the risk of developing Crohn's Disease.

These chemicals don’t directly cause IBD, but they do alter the microbes that live in our gut in significant ways.

And that’s a problem because these bugs aren’t just hanging out, they are part of an intricate, body-wide system.

Beyond the gut
The 2 -5 pounds of microbes that live inside our intestines are more than just freeloaders.

The microbiome, according to Cominelli, “is a real organ, producing hormones, neurotransmitters, and metabolites that can have very profound, significant effects.”

Our gut bacteria not only help digest our food, the more than 500 species that live inside us produce chemicals that effect our entire well-being.

Cominelli says molecules produced by bugs in our gut can even lead to anxiety or depression, "through what we call the gut-brain axis, which is basically communication between the microbiome and the brain that causes a lot of these symptoms.”

He says gut bacteria play a role in asthma, arthritis, obesity, heart disease, cancer…even Parkinson’s Disease.

And their imbalance causes Crohn’s

Cominelli is currently working on a new anti-inflammatory drug to treat the disease, but he says there are simpler options. “You can really control, or manipulate, or treat the disease by changing diet.”

The fungus among us
And that’s where Mahmoud Ghannoum comes in.

“Having imbalance in our gut is a problem,” according to Ghannoum.

“Everybody talks about bacteria, when they talk about the microbiome,” but he says that’s only half the story.

“We also need to also look at fungus because fungi live on our body and in our body, including the gut, so we should look at both,” Ghannoum said.

Ghannoum is director of the Center for Medical Mycology at University Hospitals.  He’s also a pioneer in the study of our myco-biome, or the fungus among us.

photo fo University Hospital

He’s identified 184 species of fungus in our guts that coexist with the bacteria, that is, until we alter things.

“You take oral antibiotics, you kill bacteria," Ghannoum said, "but you’re killing good and bad bacteria which keeps fungi under control.”

The fungus can then run amok.

Combating bacterial/fungal biofilms
Ghannoum has found that in Crohn’s patients, fungus joins with bad bacteria to form what he calls a bio-film.

“They create a milieu," he says, "where it’s like a small city and they’re protected.”

Bad things happen under the biofilm.

The body mounts an attack which inadvertently leads to the tissue damage typical of Crohn’s and colitis.

Ghannoum has a strategy to counteract it.

He’s developed a line of probiotics, which he claims help break down biofilms. 

And he’s written a diet bookfor your intestines, as well your palate, "because by rebalancing your bacteria and fungi, to have the good guys up and the bad guys down, you’re going to have better health.”

He’s included 50 recipes to help encourage a happy gut. 

Jeff St. Clair is the midday host for Ideastream Public Media.