ACT for Crohn's Disease and Inflammatory Bowel Disease in India | ALIV

Medically Reviewed by Dr. Sunita Tandulwadkar | Written by ALIV

Crohn's disease and ulcerative colitis — the two primary forms of Inflammatory Bowel Disease (IBD) — are immune-mediated conditions characterised by chronic, relapsing intestinal inflammation that produces significant morbidity: abdominal pain, altered bowel habits, malnutrition, anaemia, and the systemic inflammatory burden of a chronically activated immune system. While biological therapies (anti-TNF agents, anti-integrin biologics, IL-12/23 inhibitors) have transformed IBD management over the past two decades, a significant proportion of patients fail or lose response to available biologics — creating a real clinical need for additional immunomodulatory options. ACT's MSC-derived immunomodulatory mechanism addresses the same immune dysregulation from a different biological angle.

The MSC Immunomodulatory Rationale in IBD

IBD is characterised by an imbalance between effector T-cell populations (Th1, Th17) that drive intestinal inflammation and regulatory T-cell (Treg) populations that normally suppress immune overactivation. MSC-derived paracrine signals — IL-10, TGF-β, IDO (indoleamine 2,3-dioxygenase), and PGE2 — directly promote Treg induction and suppress effector T-cell function, shifting the immune balance toward tolerance. MSCs also suppress macrophage pro-inflammatory activation (M1 phenotype) in favour of anti-inflammatory (M2) activation — reducing the tissue-damaging macrophage-driven intestinal inflammation characteristic of Crohn's disease. ALIV's ACT in IBD targets these immune regulatory mechanisms systemically via IV administration — approaching the intestinal immune dysregulation from the systemic immune compartment. ACT in IBD at ALIV is positioned as an adjunct for patients in specific clinical circumstances: those who have inadequately responded to or lost response to conventional and biological therapy; those with significant steroid dependence that cannot be reduced safely; and those seeking to avoid immunosuppressive escalation while exploring regenerative immune-modulatory alternatives. It is not a first-line IBD treatment and is not appropriate for patients with active severe flares requiring hospitalisation. See the full context: ACT complete guide.

Can ACT be used during an IBD flare?

Active severe IBD flare is not the appropriate context for ACT initiation. ACT is best introduced in periods of relative remission or mild disease activity, when the immunological environment is more receptive to immune modulation. The pre-ACT consultation involves assessment of current disease activity status and determine whether the timing is appropriate. For patients with very active disease, achieving better control with current therapy before introducing ACT produces better outcomes than ACT in the context of severe flare.

Will ACT allow me to stop my IBD medications?

No — ACT is an adjunctive intervention and should not be used as a reason to discontinue prescribed IBD medications without gastroenterologist oversight. Any medication changes during or after an ACT programme should be driven by objective disease activity assessment (endoscopy, faecal calprotectin, CRP) conducted by the treating gastroenterologist. The goal of ACT in IBD is to improve the immunological environment supporting medication efficacy and to meaningfully improve quality of life and disease control — not to replace existing management.

Is ACT appropriate for perianal Crohn's disease?

Perianal Crohn's disease — fistulating perianal disease — is one area where localised mesenchymal cell administration has been studied in the literature, including early phase clinical trials of allogeneic MSC administration into fistula tracts. ALIV's ACT programme for Crohn's focuses on systemic immune modulation via IV delivery rather than local perianal administration, and is discussed in the pre-ACT consultation to determine whether systemic ACT or referral to a specialist fistula management centre is most appropriate.

Medically Reviewed by Dr. Sunita Tandulwadkar. This article is for informational purposes only and does not constitute medical advice. Therapies offered by ALIV are proprietary, experimental protocols and results vary by individual.