鸟分枝杆菌亚种副结核(MAP)和克罗恩病:争论仍在继续。

IF 3 4区 医学 Q1 Medicine Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-23-16
Michael J Mintz, Dana J Lukin
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引用次数: 1

摘要

人类的克罗恩病(CD)和反刍动物的约翰氏病(JD)有许多临床和病理上的相似之处。由于已知鸟分枝杆菌亚种副结核(MAP)作为JD的病因满足Koch的假设,在过去的一个世纪里,关于MAP是否也在CD中发挥作用一直存在相当大的争论。随着MAP鉴定技术的最新进展,我们现在可以证明与一般人群相比,MAP在CD患者中的存在更高。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,在这些患者中可能存在针对MAP的免疫反应,这可能是CD病理作用的基础。关于抗MAP治疗是否能改善CD的临床结果,临床研究得出了相互矛盾的结果,导致缺乏循证临床指南。此外,这些研究中的许多都是小病例系列,迄今为止只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MAP在人类疾病中的检测和可能的发病机制的临床和实验室数据,并提出未来的方向,最终可能为这场争论提供一些澄清。
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Mycobacterium avium subspecies paratuberculosis (MAP) and Crohn's disease: the debate continues.

Crohn's disease (CD) in humans and Johne's disease (JD) in ruminants share numerous clinical and pathologic similarities. As Mycobacteria avium subspecies paratuberculosis (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.

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来源期刊
CiteScore
8.20
自引率
0.00%
发文量
1
期刊介绍: Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.
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