Human Para is pleased to share the consensus article from the 2017 MAP conference in Philadelphia. This effort represents a historic collaboration of the world’s experts on Mycobacterium avium spp. paratuberculosis (MAP), who are concerned about the impact of MAP on human health. The goal of this collaboration is to advance better treatment options for patients suffering from MAP-driven conditions.
Dr. Nicole Parrish of the Johns Hopkins School of Medicine and Dr. Neil Goldberg of the University of Maryland, begin the presentation by discussing tuberculosis and the Wayne Model of Non-Replicating persistence, and how that model relates to MAP latency. Their research shows that MAP can convert from an aerobic (oxygen using) state to an anaerobic (non-oxygen) state similar to that seen in tuberculosis. The presentation concludes with a discussion of MAP antibiotic susceptibility and a case study where a combination of antibiotics led to cessation of Crohn’s disease and pyoderma gangrenosum.
In these first two videos, Dr. Behr and Dr. Chamberlin introduce the conference, frame the issue of MAP and address the issue of causality.
Dr. Collins gives an overview of MAP from a veterinary perspective, including where MAP is found in the environment, hallmarks of MAP infections in cows and other animals and detection methods. Contamination of MAP in food products and human exposure vehicles are discussed alongside solutions which can be implemented to stop the spread of MAP.
Dr. Kapur, of Penn State, looks at the prevalence and cost of MAP infection in cattle, and discusses the diagnostics available, which are a particular challenge. It’s difficult to get accurate, early testing, so MAP infection spreads, especially in large herds. Interestingly, Dr. Kapur has found that certain MAP proteins appear early on in infection (as early as 2-3 months), but then are detected less frequently in clinical disease.
Dr. Marcel Behr is a Full Professor of Medicine and Fellow of the Canadian Academy of Health Sciences as well as the Director of the McGill International TB Centre and Microbiologist-in-Chief at the hospital. Here, Dr. Behr talks about the nature of MAP as compared to tuberculosis, and explains the challenges of finding MAP in human samples and why some testing for MAP gives false positives. He explains the gold standard of culture for human MAP and why MAP may not be present the feces. Questions from the audience follow the presentation.
Dr. McNees is an associate of Dr. David Graham in the Department of Molecular Virology and Microbiology at the Baylor College of Medicine in Houston, TX. She talks about their methods to detect MAP in human subjects using culture and PCR, and discusses their results. MAP was detected in 70% of Crohn’s disease patients and 48.9% of controls. When the disease is in the colon, more cases are MAP-positive.
Dr. Shoor Vir Singh is a Principal Scientist at the Indian Council of Agricultural Research. He was unable to present at the 2017 MAP Conference due to a prior commitment, but has kindly provided his presentation materials. The presentation begins with an overview of MAP in India, and progresses to a detailed case study of a Crohn’s disease patient whose stool sample tested positive for Indian bison type MAP. After a year of antibiotic treatment, his Crohn’s disease symptoms had abated and MAP testing was negative. The antibiotic treatment regimen is detailed in Dr. Singh’s presentation. The final portion of the presentation describes treatment and control strategies for MAP in India, including an indigenous bison-type vaccine that is now available.
“Understanding Crohn’s disease is not rocket science — It is far more complex.” In this presentation, John Aitken from Otakaro Pathways in New Zealand discusses his efforts to reliably culture MAP from human patients. The issue of dormancy is outlined, along with the results of a recent testing study conducted with a 28 subject cohort. A mechanism is proposed for how MAP behaves to cause disease in the human population.
Dr. Bach is an Adjunct Professor in the Division of Infectious Diseases at the University of British Columbia in Vancouver, Canada. His research interests include understanding how pathogenic microorganisms successfully infect and multiply in humans, nanomedicine and antibody design. In his presentation, Dr. Bach discusses how MAP can survive in the macrophage and levels of antibodies found in Crohn’s patients vs. healthy control. Antibody levels are measured before and after traditional Crohn’s disease treatments are administered.
