Comprehensive look at MAP

I've always been fond of the idea that Crohn's is caused by MAP, and that it will be easily cured by a short course of antibiotics. A comprehensive look into how this proposition stands today is made by the American Society for Microbiology in their report "Mycobacterium avium paratuberculosis: Infrequent Human Pathogen or Public Health Threat?".

One acknowledged potential microbial agent of CD is Mycobacterium avium subspecies paratuberculosis (MAP), a microorganism that causes a gastrointestinal disease similar to CD in ruminants, including dairy cattle, called Johne’s disease (or paratuberculosis). People with CD have 7:1 odds of having a documented presence of MAP in blood or gut tissues than those who do not have CD, thus the association of MAP and CD is no longer in question (see Figure 1, page 11). The critical issue today is not whether MAP is associated with CD, but whether MAP causes CD or is only incidentally present, not an inciter or participant in the disease process.

They include a table of virtually all current Crohn's medications, their dosage and costs. This is very handy information that I haven't seem summarised anywhere before.

In addition, they cover:

• possible causes of Crohn's
• where MAP comes from and whether it can affect humans
• treatment of MAP in humans
• whether MAP causes Crohn's
• where future MAP research should be headed

On a hopeful note, they mention the success that anti-MAP treatments have had against Crohn's:

Treatment of some CD patients with antibiotics that have activity on certain other Mycobacteria, although not specifically selected for their activity against MAP, provides short-term or long-term relief or remission of symptoms.

Everything is written in a medical-jargon-free manner, so it's easy to understand. In addition, a brief summary is also available at Medical News Today.

Post AntiTNF biologics

The most recent successfully-introduced medications for the treatment of Crohn's disease, infliximab and adalimumab, have targeted tumor necrosis factor (TNF). However, they are ineffective for some people, and become ineffective in others over time. The Lancet(free registration required) reports some of the different directions that researchers have been examining for further biologic agents, their safety and effectiveness in trials.

Investigators have long sought to identify a micro-organism that causes inflammatory bowel disease. The present theory suggests a breakdown in the balance
between putative species of protective versus harmful bacteria—a notion that has been termed dysbiosis.

Whilst many current drugs reduce the symptoms of Crohn's by suppressing the immune system, research is continuing into drugs that act as immune stimulators.

As a result of decades of intensive research, treatment for inflammatory bowel disease is undergoing a transition from the era of TNF antagonists to an era of novelbiological agents, including those that are able to stimulate the innate immune system.

As you might expect for a medical journal it's quite a technical article, but well worth the effort to see what possible treatments are just around the corner. For easier reading there's a summary at Medical News Today.