Researchers at Weill Cornell Medicine have discovered a groundbreaking approach to treating short bowel syndrome by reprogramming cells in the large intestine to function like the nutrient-absorbing small intestine. The study, published April 3 in Gastroenterology, demonstrates that deleting a single gene can reverse the malnutrition that typically results when most of the small intestine is removed.
Short bowel syndrome affects an estimated 10,000 to 20,000 people in the United States. The life-threatening condition occurs when very little of the small intestine remains after surgical removal due to chronic inflammation, cancer, trauma, or congenital conditions. Because the small intestine is the primary site for nutrient absorption in the gastrointestinal system, patients often require total parenteral nutrition, receiving all nutrients intravenously.
SATB2 Gene Deletion Transforms Colon Cell Identity
The research team found that knocking out the SATB2 gene in the colon prompts cells in the upper colon to transform into small intestine-like cells, specifically resembling those found in the ileum—the lowest portion of the small intestine.
"Our demonstration may help pave the way for a future gene therapy for short bowel syndrome," said study senior author Dr. Xiaofeng Steve Huang, an assistant professor of molecular biology research in medicine and a member of the Hartman Institute for Therapeutic Organ Regeneration at Weill Cornell Medicine.
This discovery builds on the team's previous research published in 2021, which first identified SATB2's crucial role in maintaining colon cell identity. In that earlier work, they demonstrated that deleting this gene in either mouse or human colon cells causes them to adopt characteristics of ileal cells.
Dramatic Survival Improvements in Preclinical Models
In the current study, the researchers tested whether deleting the SATB2 gene could improve nutrient absorption in preclinical models of short bowel syndrome. The results were striking: mice that underwent SATB2 deletion quickly regained normal weight, and 80% survived beyond 60 days. In contrast, only 10% of control mice that retained the gene survived to the 60-day mark.
Detailed analysis revealed that the tissue structure and vasculature in the upper colons of treated mice closely resembled ileal tissue, enabling ileum-like nutrient absorption. This transformation effectively compensated for the missing small intestine function.
Moving Toward Human Applications
Taking a significant step toward potential human gene therapy, the researchers tested their approach using "organoids"—small, organ-like tissue structures derived from human colon cells. They employed an adenovirus-associated virus (AAV) to deliver a gene editor for deleting SATB2.
The results were promising: the treated human colon organoids successfully transformed to become ileum-like and survived when transplanted into mice. This demonstration in human tissue suggests the approach could potentially be translated to clinical applications.
Dr. Tao Liu and Dr. Shiri Li served as co-first authors of the study. The research was conducted in collaboration with the laboratory of Dr. Qiao Zhou, professor of regenerative medicine at Weill Cornell Medicine, who helped initiate and guide the study before his passing in June 2024.
Future Directions
The research team is continuing to develop their therapeutic strategy and plans to test it on more advanced preclinical models of short bowel syndrome.
"This approach represents a potentially transformative treatment option for patients with short bowel syndrome, who currently have limited therapeutic alternatives," Dr. Huang explained. "By reprogramming existing colon tissue to take on small intestine functions, we may be able to restore nutrient absorption without the need for invasive surgery or lifelong intravenous nutrition."
The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, as well as Weill Cornell Medicine, a Tri-Institutional Stem Cell grant, and funding from Sanofi.
