With nearly 1.5 million people in the United States living with rheumatoid and juvenile arthritis, effective and consistent symptom management remains a challenge. Researchers at Shriners Children’s St. Louis have introduced a new approach, termed “chronotherapy,” which aligns drug delivery with the body’s natural circadian rhythm. The research, led by Dr. Farshid Guilak and published in Nature Communications, explores how bioengineered stem cells can automatically release anti-inflammatory drugs at optimal times of day.
The body’s circadian rhythm, a 24-hour cycle that regulates various physiological functions, plays a role in inflammation levels. Many arthritis patients experience peak inflammation and pain between 3 a.m. and 5 a.m., long before they would typically take medication. To address this, the research team developed “chronogenetics”—a system in which stem cells are engineered with circadian-based gene circuits. Once implanted, these cells synchronize with the patient’s internal clock and deliver medication precisely when it is needed.
“This is the first time that the cell’s internal clock has been used for controlling drug delivery,” said Dr. Lara Pferdehirt, first author of the study. While previous research from the same lab developed smart cells that release medication in response to inflammation, this new method automates drug production based on the body’s daily biological cycles.
Dr. Guilak emphasized the potential long-term impact of the findings, suggesting that aligning medication with the circadian rhythm could not only reduce pain and inflammation but might also alter the course of diseases like rheumatoid arthritis. He noted that this approach could extend beyond arthritis to conditions such as cancer or diabetes, which also exhibit circadian patterns.
The research team is working with the FDA to begin clinical trials within the next 3–5 years. This method could lead to a significant shift in how chronic inflammatory conditions are treated, potentially reducing reliance on frequent injections and improving overall disease management.
