Mintz Michael J, Lukin Dana J
Division of Gastroenterology and Hepatology, New York Presbyterian Hospital-Weill, Cornell Medicine, New York, NY, USA.
Jill Roberts Center for Inflammatory Bowel Disease, New York Presbyterian Hospital-Weill, Cornell Medicine, New York, NY, USA.
Transl Gastroenterol Hepatol. 2023 Jul 25;8:28. doi: 10.21037/tgh-23-16. eCollection 2023.
Crohn's disease (CD) in humans and Johne's disease (JD) in ruminants share numerous clinical and pathologic similarities. As subspecies (MAP) is known to fulfill Koch's postulates as the cause of JD, there has been considerable debate over the past century about whether MAP also plays a role in CD. With recent advances in MAP identification techniques, we can now demonstrate a higher presence of MAP in CD patients compared to the general population. However, it remains unclear if MAP is playing a bystander role or is directly pathogenic in these patients. Studies have shown that there may be an immune response targeting MAP in these patients, which may underlie a pathologic role in CD. Clinical studies have yielded conflicting results as to whether anti-MAP therapy improves clinical outcomes in CD, leading to the lack of its inclusion within evidence-based clinical guidelines. Additionally, many of these studies have been small case series, with only a few randomized controlled trials published to date. In this article, we will discuss the historical context of MAP in CD, review clinical and laboratory data surrounding detection of MAP and possible pathogenesis in human disease, and suggest future directions which may finally provide some clarity to this debate.
人类的克罗恩病（CD）和反刍动物的副结核（JD）在临床和病理方面有许多相似之处。由于已知副结核分支杆菌（MAP）作为JD的病因符合科赫法则，在过去的一个世纪里，关于MAP是否也在CD中起作用一直存在相当多的争论。随着MAP鉴定技术的最新进展，我们现在可以证明与普通人群相比，CD患者中MAP的存在率更高。然而，尚不清楚MAP在这些患者中是起旁观者作用还是直接致病。研究表明，这些患者可能存在针对MAP的免疫反应，这可能是其在CD中发挥病理作用的基础。关于抗MAP治疗是否能改善CD的临床结局，临床研究得出了相互矛盾的结果，导致其未被纳入循证临床指南。此外，这些研究大多是小病例系列，迄今为止仅有少数随机对照试验发表。在本文中，我们将讨论MAP在CD中的历史背景，回顾围绕MAP检测以及人类疾病中可能的发病机制的临床和实验室数据，并提出未来的方向，这最终可能为这场争论提供一些清晰的答案。
