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Understanding the Emergence of Crohn’s Disease in South Asians

Groundbreaking research study sheds light on environmental factors that may contribute to a growing incidence of Crohn’s disease

Over the past two decades, the incidence of Crohn’s disease (CD) has been rising across the globe. Notably, this increase has been particularly rapid in regions of Asia that are also undergoing shifts from a traditional to a more Western diet and lifestyle. Is the intrusion of Western culture on their lives contributing to a rise in CD among South Asians? Are diet and lifestyle choices triggering the onset of this chronic disease? Does where you live have an impact on disease etiology? A $1.6 million study, funded by the Helmsley Charitable Trust, and conducted at the Crohn’s and Colitis Center at Massachusetts General Hospital, seeks to answer these and other questions, and offer new insights into the development of CD among South Asians.

The study, titled “Crohn’s Disease in South Asians: Defining disease biology for prevention and better treatment,” aims to better inform efforts to prevent CD and treat people living with the disease, by defining its biological and environmental determinants within an ethnically-distinct patient population. By conducting a comprehensive, comparative analysis of native and immigrant South Asians with similar genetics, this groundbreaking approach looks to identify environmental triggers for CD, and the window of time during which individuals are most susceptible to such triggers.

“In this study, the team at Massachusetts General Hospital will assemble a unique international cohort of immigrant and native South Asian CD patients and healthy controls to identify characteristics of CD that are unique to the South Asian population and the environmental triggers in Western culture that are contributing to the rising incidence of CD in the developing world,” said Dr. Shefali Soni, Program Officer of Helmsley’s Crohn’s Disease Program.

Dr. Ashwin Ananthakrishnan, associate professor of medicine at Harvard Medical School and director of the Crohn’s and Colitis Center at Massachusetts General Hospital.

Dr. Ashwin Ananthakrishnan

The research will focus on an assessment of the environmental exposures of 150 CD patients in South Asia and 150 immigrant South Asian CD patients in the U.S., and 300 healthy control participants. This will include profiling the exposome (one’s environmental exposures), epigenome (alterations to one’s genes), and serum metabolome (small molecules found in our bodies) of subjects, and to assess how these factors can be manipulated for disease prevention and treatment through diet, lifestyle, or microbiome-directed therapy.

“Until a cure for Crohn’s disease is found, Helmsley’s Crohn’s Disease Program is committed to improving patients’ everyday lives. With no known cause and a growing commonality worldwide, Helmsley has identified a need to focus on the impact of the environment on disease pathogenesis to uncover risk factors and define avenues to prevent the onset and delay the progression of Crohn’s disease,” said Pretima Persad, Program Officer of Helmsley’s Crohn’s Disease Program.

This research project is a collaboration between the Prevention and Disease Management teams of Helmsley’s Crohn’s Disease Program. The study is being conducted over three years and is being led by Dr. Ashwin Ananthakrishnan, an associate professor of medicine at Harvard Medical School and director of the Crohn’s and Colitis Center at Massachusetts General Hospital.

“Unravelling the reasons for the emergence of Crohn’s disease in regions where it was previously exceedingly rare is going to one of the most important challenges facing the inflammatory bowel disease community in the coming years,” said Dr. Ananthakrishnan. “A careful and comprehensive study of populations undergoing rapid changes in the environment, be it through westernization or immigration, offers one of the most powerful tools to help us understand the mystery of Crohn’s disease and make progress towards preventing it.”

Considering the recent global trends in the emergence of CD, the definition of disease-specific biology across different ethnic populations promises to fill a critically important knowledge gap. These findings will guide the development of preventive interventions and therapeutic strategies and will serve to advance Helmsley’s mission of improving the health and well-being of CD patients around the world.