Aitken John M, Aitken Jack E, Agrawal Gaurav
Otakaro Pathways Ltd., Innovation Park, Christchurch 7675, New Zealand.
Division of Diabetes & Nutritional Sciences, Franklin-Wilkins Building, King's College London, London SE1 9NH, UK.
Antibiotics (Basel). 2024 Feb 5;13(2):158. doi: 10.3390/antibiotics13020158.
ssp. (MAP) is the cause of Johne's disease (JD), which is a chronic infectious gastrointestinal disease of ruminants and is often fatal. In humans, MAP has been associated with Crohn's disease (CD) for over a century, without conclusive evidence of pathogenicity. Numerous researchers have contributed to the subject, but there is still a need for evidence of the causation of CD by MAP. An infectious aetiology in CD that is attributable to MAP can only be proven by bacteriological investigations. There is an urgency in resolving this question due to the rising global incidence rates of CD. Recent papers have indicated the "therapeutic ceiling" may be close in the development of new biologics. Clinical trial outcomes have demonstrated mild or inconsistent improvements in therapeutic interventions over the last decades when compared with placebo. The necessity to revisit therapeutic options for CD is becoming more urgent and a renewed focus on causation is essential for progress in identifying new treatment options. This manuscript discusses newer interventions, such as vaccination, FMT, dietary remediation and gut microbiome regulation, that will become more relevant as existing therapeutic options expire. Revisiting the MAP theory as a potential infectious cause of CD, rather than the prevailing concept of an "aberrant immune response" will require expanding the current therapeutic programme to include potential new alternatives, and combinations of existing treatments. To advance research on MAP in humans, it is essential for microbiologists and medical scientists to microscopically detect CWDM and to biologically amplify the growth by directed culture.
副结核分枝杆菌(MAP)是约内氏病(JD)的病因,约内氏病是反刍动物的一种慢性传染性胃肠疾病,通常是致命的。在人类中,一个多世纪以来,MAP一直与克罗恩病(CD)相关,但尚无致病性的确凿证据。众多研究人员都参与了该课题的研究,但仍需要MAP导致CD的证据。CD中可归因于MAP的感染性病因只能通过细菌学调查来证实。由于全球CD发病率不断上升,解决这个问题迫在眉睫。最近的论文表明,新生物制剂的研发可能已接近“治疗上限”。与安慰剂相比,过去几十年的临床试验结果显示治疗干预的改善轻微或不一致。重新审视CD的治疗选择变得更加紧迫,重新关注病因对于确定新的治疗选择至关重要。本手稿讨论了更新的干预措施,如疫苗接种、粪便微生物群移植、饮食调整和肠道微生物群调节,随着现有治疗选择的到期,这些措施将变得更加重要。重新审视MAP理论作为CD潜在的感染性病因,而不是流行的“异常免疫反应”概念,将需要扩大当前的治疗方案,纳入潜在的新替代方案以及现有治疗方法的组合。为了推进对人类MAP的研究,微生物学家和医学科学家必须通过显微镜检测细胞壁缺陷型MAP,并通过定向培养进行生物学扩增以促进其生长。