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Amy Lightner, MD joins Butts & Guts to discuss Inflammatory Bowel Disease (IBD) and innovative treatments using stem cell therapy at Cleveland Clinic's Center for Regenerative Medicine & Surgery. Dr. Lightner also gives an update on the 2022 Sherman Prize and how you can submit a nomination.

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Contributions in the Fight to Overcome IBD

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi, everybody, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. It's always a pleasure for me to have returning guests. I think this is, at last count, a three time returning guest - Dr. Amy Lightner, who is a world renowned colorectal surgeon in our department. And she's the Director of our Cleveland Clinic Center for Regenerative Medicine and Surgery within our Digestive Disease & Surgery Institute. Dr. Lightner, welcome back to Butts & Guts.

Dr. Amy Lightner: Thank you for having me.

Dr. Scott Steele: Awesome. So today we're going to talk a little bit about something in terms of the fight to overcome IBD. So for those who haven't heard you on the past, can we first start a little bit about your background. Where you're from, maybe throwing a tidbit that they haven't heard in the past? Tell us about, maybe a sport you played in college, and how did it come to the point that you're here at the Cleveland Clinic?

Dr. Amy Lightner: Yeah. So I'm from San Diego, California. And being from San Diego, a lot of us are swimmers and I actually played water polo through high school and college. I was at college at Stanford University and then went to Boston University for medical school, and then back to the west coast to UCLA for my surgical training. And did a postdoc at Stanford in stem cell biology during that time. And finished off my training at Mayo Clinic, and then came here to Cleveland's.

Dr. Scott Steele: We are lucky enough to have you too. So we're going to talk a little bit about IBD, or inflammatory bowel disease. A lot of people think IBD, they think IBS. Two completely different things. We're talking about IBD inflammatory bowel disease. Amy, tell us a little bit about an overview. What is this disease, the different types, and how common is it?

Dr. Amy Lightner: Yeah, so inflammatory bowel disease has two main phenotypes, both ulcerative colitis and Crohn's disease are two ways that inflammatory bowel disease can present. And actually it affects about three million people in the United States alone. And it's certainly on the rise. We don't know exactly why these numbers are increasing, but we're seeing increasing rates of Crohn's and ulcerative colitis worldwide and in the United States.

Dr. Scott Steele: So is IBD curable? And is there a difference between, quote-unquote, cure with the ulcerative colitis patients versus Crohn's?

Dr. Amy Lightner: Yeah. Unfortunately, IBD is not curable, or not curable yet. But we do have good medical therapies, and we have surgery which can certainly help cure the intestinal part of the disease. For ulcerative colitis, we have a lot of medical therapies, but about 25% of our patients will still need surgery. And when we do surgery and remove the colon and the rectum, we actually can cure them of their intestinal part of ulcerative colitis.

Crohn's disease, we have a lot medical therapies for, but a lot of patients will need surgery because their intestine becomes a bit damaged in certain areas. And we have to take those portions of damage out to help them with symptom control. But after we do that, generally patients go back on some sort of medical therapy. So we're still not at the point yet where we found a cure, but we're still working on that.

Dr. Scott Steele: Well, it's been great to have you here at the tip of the spear in terms of innovative practices. And for those of you who were listening to the intro, you heard me say regenerative medicine. Once I brought up regenerative medicine and somebody said, oh, it's that one of those tanks that you go into in the future and get ... I mean, it could be all over the map in terms of what they think it is. So before we delve into regenerative medicine as it relates to IBD, what's regenerative medicine, what does that mean?

Dr. Amy Lightner: Yeah. So good question. It definitely encompasses a lot of different therapies. But when we think about it in terms of offering new therapies for patients and research, we think mostly in the space of cell therapy or using therapies that come from our own body. Whether that be stem cells, mesenchymal stem cells, whether that be organoids that we grow from organ tissue, but basically things that are a non-pharmaceutical. So things that we can derive from human tissue and then give them back as a therapeutic.

Dr. Scott Steele: Can you talk a little bit about your work within Cleveland Clinic Center for Regenerative Medicine and Surgery, and how that's contributing to the fight against inflammatory bowel disease?

Dr. Amy Lightner: Yeah. We have been able to do a lot of clinical trials, mostly for patients with inflammatory bowel disease, for Crohn's disease and ulcerative colitis. And so we're using cell therapy, so mesenchymal stem cells. These are adult stem cells that come from healthy donors, from bone marrow or from fat tissue. And the cells themselves are very anti-inflammatory and they modulate the immune system in a way that is helpful for patients with Crohn's disease and ulcerative colitis, and they repair tissue. So we create cell banks here at Cleveland Clinic, and we grow these banks and make doses of cells to give to patients.

And the patients we've been treating mostly are those with Crohn's disease that have a fistula tract around their bottom. And so we inject cells into that area to help them repair those fistula tracks. We've also started doing some trials for patients that have intestinal disease. And so we inject the cells right into the areas of inflammation, or we give the cells intravenously while the patients are in a outpatient clinic setting.

Dr. Scott Steele: I know that we've had podcasts on the past, and I know you've published a lot of papers on this, but can you give the audience maybe just regards to some of the fistulas you were talking about? Which again, is a tract from one place to another, and where it shouldn't be. How is it working?

Dr. Amy Lightner: Yeah, so it's actually working very well. We just reported our six month results. So our six month healing rates for fistulas are 85%. So we had a rate that 97% of patients improved, but 85%, the fistulas completely dried up. So no more drainage at all, and patients were effectively cured of their fistulas.

Dr. Scott Steele: That's fantastic. And I know I speak for the both of us and many other people out there that there are organizations out there who are willing to donate funds in order to be able to look into innovative practices. And one of which is the Sherman Prize. Can you talk about this prize and the organization?

Dr. Amy Lightner: Yeah. The Sherman Prize was started by Bruce and Cynthia Sherman, and they have been very generous to, basically donate money to create awareness around inflammatory bowel disease. Bruce Sherman, he had a couple of family members that had Crohn's disease and really suffered from Crohn's. And he realized that there wasn't necessarily as much awareness as he thought, as he was watching his family members go through the process of receiving care. And so he really wanted to come up with a way to raise awareness, and then honor people in the field that are doing innovative work. And it's really designed for any healthcare provider that is making an impact in space of inflammatory bowel disease.

And what it is, is that we put together a peer group. There's five of us, it's led by Maria Abreu. And people submit nominations, and then the peer group reviews the nominations as to how these people have had an impact in the field of inflammatory bowel disease. And then three winners are selected each year. And those winners are honored at one of our annual meetings, Advances in Inflammatory Bowel Disease, which happens in December in Florida. And it's a really nice award. It's presented by a peer, a medical provider in the realm of inflammatory bowel disease. They do a very nice video on the healthcare provider, and that provider receives funds to help lead efforts in research or in clinical practice or whatever way they're working in the healthcare field of inflammatory bowel disease.

Dr. Scott Steele: How can a medical professional that's listening nominate someone, or can you even self-nominate for this prize? Where do they go to, what do they do?

Dr. Amy Lightner: It can be a healthcare provider that nominates you. It can be a patient that nominates. It can be a friend that nominates. So anyone can nominate someone by just going to shermanprize.org. And then there's a big link on that page that says nominate now. And it's a quick form, it's one page with a few questions. And we're taking nominations up until June 8th this year. And then the committee meeting will meet after that. But it's open to anyone to nominate.

Dr. Scott Steele: So that's shermanprize.org. So S-H-E-R-M-A-N P-R-I-Z-E dot org. I hope that there's a lot of people that will be able to go to that. Because again, this is a tremendous opportunity to not only recognize somebody for having an innovative and leadership in the field, but it's also an opportunity to help out our patients with this disease. At the end of the day, that's what we're all about this for. So congratulations on that. And that's wonderful that you're being a part of this.

You know, Amy, one of the things that we like to do on here is get to know all of our guests a little bit better. And you've answered some questions in terms of this, some of these quick hitters. So number one, salt or sweet?

Dr. Amy Lightner: Salt.

Dr. Scott Steele: Having said that, what's your favorite candy bar?

Dr. Amy Lightner: Hershey.

Dr. Scott Steele: Just a plain old, brown wrapper Hershey chocolate? Whoa, there we go. Old school. So, the first car that you've ever had?

Dr. Amy Lightner: Was a Ford pickup truck.

Dr. Scott Steele:  Are we talking extra king cab or F150 or a Ranger? What are we talking about?

Dr. Amy Lightner: A Ford Ranger.

Dr. Scott Steele: Ford Ranger. A nice little back-wheel drive Ford Ranger, where the back window was right at your head. I like that old truck. And then finally, Amy, you have traveled the world as a world expert, not only in regenerative medicine, but in colorectal surgery. So what is a country that you haven't been to that you'd like to travel to?

Dr. Amy Lightner: I'd like to go to Japan.

Dr. Scott Steele: Japan. That's fantastic. Yeah. I agree with you there. It looks like, just a beautiful country. So what's the final take home message for our listeners? And if you could just, again, give that Sherman Prize nomination info one more time?

Dr. Amy Lightner: Yeah, I think it's just ... it's a really nice award that's been created by a very generous family to raise awareness in inflammatory bowel disease. It is certainly helpful, as it's a monetary award, and those funds are used for the treatment of our patients. Whether that be through innovative research, whether that be to hire more APPs for clinical practice or set up a new clinic and outreach for inflammatory bowel disease patients.

But there are some really wonderful providers in our field doing great work in inflammatory bowel disease. So it's a nice way to honor them and to be able to give back to our patients. And again, this can come from patient nomination or a friend or another colleague that you work with.

Dr. Scott Steele: Well, that's fantastic. And to learn more about inflammatory bowel disease treatment here at Cleveland Clinic Center for Regenerative Medicine and Surgery, please visit clevelandclinic.org/crms. That's clevelandclinic.org/crms. And to speak with a specialist in our Digestive Disease & Surgery Institute, please call 216.444.7000. That's 216.444.7000.

And again, please remember, it's important for you and your family to continue to receive medical care, regular checkups, and screenings. And rest assured, here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers. Dr. Lightner, thanks so much for joining Butts & Guts once again.

Dr. Amy Lightner: Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.

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Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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