Medical Mystery Revealed: Link Between ‘Creeping’ Fat and Bacteria in Crohn’s Patients Found

In many Chrohn's disease patients, abdominal fat migrates to the inflamed small intestines' wall. What stimulates the fat tissue to "creep" through the abdomen and wrap many patients' intestines with this condition, also known as IBD or inflammatory bowel disease, has been an enduring mystery.

In a study the journal Cell published this week, investigators from Cedars-Sinai presented the fat's strange creeping activity initially appearing to be protective but later ends up causing more harm than good.

According to the study's lead author and principal investigator, Suzanne Devkota, Ph.D., creeping fat is frequently a breakthrough for surgeons who perform resections on the bowel of an IBD patient as they know it as a possible location for lesions.

However, Devkota added, "We don't know where the presence of that fit" is worsening the disease or trying to shield the intestine from something.

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Small Intestine and Fat Tissue Studied

Together with a team of researchers, the principal investigator performed comprehensive molecular studies of the small intestine and fat samples from 11 patients with Crohn's disease and had gone through surgery.

Adipose tissue or commonly known as fat, the study authors described, "Is more than an energy storehouse." It is an active endocrine tissue rich in immune cells that appear to be activated in specific IBD cases.

Relative to these investigations, Devkota said they "found that adipose tissue is responding to bacteria" that have migrated out of the damaged intestines and directly into the fat of a patient.

The lead author added they believe the fat's 'creeping' migration around the intestines is intended to plug leaks in the inflamed organ to stop the gut bacteria from entering into the patient's bloodstream.

No 'Off' Switch

The reaction that starts as protective though, the investigators found, has no 'off' switch. Meaning, if the bacteria remain in the fat, they will continue migrating to a possible source of the gut bug.

Nonetheless, the fat's presence, the study found, maybe a contributor to the occurrence of fibrosis or severe intestinal scarring, occurring in 40 percent of patients with Crohn's disease.

For such an occurrence, the investigators suggested that the only option for many patients is the surgical removal of parts of the small bowel, which has life-changing consequences.

Patients suffering from the other common IBD known as ulcerative colitis do not develop 'creeping' fat. The data led study authors to a particular microbe that's responsible for stimulating the fat to 'creep' through the small intestine and protectively enclose the organ, jeopardizing its function.

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Pathogen Identified

Devkota said they identified Clostridium innocuum, a pathogen found in the digestive system, as the bacterial invader that prompts the fat to" 'creep' over to the small bowl."

According to the study's co-investigator, David Underhill, Ph.D., this specific infectious agent's structure makes it well-matched for a lipid-filled environment.

Underhill is also the chair of Biomedical Sciences and the Janis and William Wetsman Family Chair in Inflammatory Bowel Disease at Cedars-Sinai.

The Cedars-Sinai experts also said that this particular study could lead the way to new treatments and improve the lives of the patients with IBD, which is the main objective of this project.

F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute at Cedars-Sinai director, Stephan Targan, MD said, they have identified a particular infectious agent that can activate the process worsens Crohn's disease.

Targan added this is a crucial step toward developing therapeutics that target Clostridium innocuum, enabling them to avert or reduce 'creeping' fat's damaging effect.

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