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The dangers using the wrong antibiotics that are ineffective against AIEC.

https://academic.oup.com/ibdjournal/article-abstract/25/4/711/5218864?redirectedFrom=fulltext

Inflammatory Bowel Diseases, Volume 25, Issue 4, April 2019

Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.

Oberc, Fiebig-Comyn, Tsai CN, Ethenawy W, Coombed BK

Antibiotics Potentiate Adherent-Invasive E. coli Infection and Expansion

''BACKGROUND:
Crohn's disease (CD) is an inflammatory bowel disease with a complex etiology. Paradoxically, CD is associated with the use of antibiotics and with an increased abundance of an unusual phenotypic group of Escherichia coli known as adherent-invasive E. coli (AIEC). However, the impact of antibiotics on AIEC infection has not been well studied in controlled models of infection.

METHODS:
We infected mice with AIEC before or after treatment with a variety of different classes of antibiotics. We assessed levels of AIEC in the feces and tissues, AIEC localization by immunofluorescence microscopy, and tissue pathology.

RESULTS:
We found that a wide range of antibiotic classes strongly potentiated initial AIEC infection and expanded AIEC in chronically infected mice. We found that the ability of antibiotics to potentiate AIEC infection did not correlate with a stereotyped shift in the gut bacterial community but was correlated with a decrease in overall diversity and a divergence from the pre-antibiotic state. We found that antibiotic-induced inflammation provided a fitness advantage for AIEC expansion through their use of oxidized metabolites in the postantibiotic period.

CONCLUSIONS:
Our results show that antibiotics can render hosts more susceptible to initial AIEC infection and can worsen infection in previously colonized hosts. AIEC appears to exploit host inflammatory responses that arise in the postantibiotic period, highlighting a previously unknown interaction between CD risk factors.''
 
Kiny, thank you for posting lots of good articles. I wish this last one at the beginning of the article hadn’t mentioned the Selby trial as failing to show that MAP is the culprit. I feel compelled to post Marcel Behr’s reanalysis of that study: https://www.semanticscholar.org/paper/Antimycobacterial-therapy-for-Crohn's-disease:-a-Behr-Hanley/5ef2b37e4801e4519e46811724858ffb4b52ef6f
and here is another intriguing piece about how infliximab (Remicade) is actually detrimental to MAP as it tames the TNFa response: https://academic.oup.com/ecco-jcc/article/6/5/628/2392344?fbclid=IwAR2Q8cxLTDrJExefOdh9Ydr7mC9p7l7xtoivu3gCvgcUVYZ4_J-RwM2T4XA

You may be right though that Crohn's could also be caused by AIEC. Dr. Jeremy Sanderson in London, who I believe will be running the vaccine trial has published extensively about this possibility and even John Hermon-Taylor has too. Or since new bacteria and viruses are being discovered so frequently perhaps one of them or several are responsible. I am also learning to embrace diet as a possible way to achieve remission. I am hearing about more and more people succeeding that way. Please keep the articles coming!
 
The incubation period of paratuberculosis is long in ruminants, years. MAP can take months to culture.

Why did several people relapse within weeks after, or even during, anti-MAP antibiotics treatment if the antibiotics were killing MAP. MAP divides extremely slowly, even if MAP became resistant, people shouldn't be relapsing so quickly.

I think if you are going to give people antibiotics specific for MAP, you have to be able to detect MAP with IS900PCR and you need to culture it from the patient and do an antibiotics susceptibility test, before you start treatment.

If you don't do that, you will be using antibiotics which might be effective against mycobacteria, but aren't effective to treat enterobacteriaceae such as E coli, a bacteria that, unlike MAP, is now readily found in ileal crohn's disease. You willl make matters worse for the patient when they relapse if you are using antibiotics to treat mycobacterial infections when the culprit in the patient is E coli.
 
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Just to be clear, my problem with these ''anti-MAP cocktail studies'' isn't MAP. The fact a mycobacteria that causes disease in animals is in the human food chain, needs to be looked at, it should have been looked at decades ago when Dalziel pointed it out.

My problem is that people are apparently being given these broad spectrum ''anti-MAP antibiotics cocktails'' without knowing if MAP is the culprit, they don't even try to culture MAP from these patients.

There is reason to believe that these antibiotics cocktails might make matters worse.

1) antibiotics use predisposes people to develop crohn's disease
2) antibiotics with a subsequent E Coli infeciton is used to mimmick crohn's disease in mice
3) we have a pretty accurate model how antibiotics cause dysbiosis and gives AIEC a fitness advantage in CD patients
4) those anti-MAP antibiotics are highly ineffective against crohn's disease associated E Coli, yersinia, salmonella and enterobacteriaceae in general
5) those people on ''anti-MAP cocktails'' have not been tested for the presence of MAP, from what I am reading


In the Selby anti-MAP antibiotics trial 59% of the antibiotic group and 50% of the placebo group relapsed within a year. It doesn't make any sense to have so many people relapse so quickly if the culprit was a slow dividing bacteria like MAP. If the culprit was MAP, they should have stayed in sustained remission. Paratuberculosis incubation period for MAP can be 4 or 5 years in ruminants.
 
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Ah! I like this! You are making me think! I totally get your concern and have thought the same. A few answers that I can provide: many people are tested for MAP BUT with tests that are not validated so none of those tests will be considered acceptable evidence by the scientific community. However, people who are tested trust the results anyway and are confident it shows MAP infection. From what I understand the AMAT cocktail was created to specifically target MAP, and I also understand that the fact that there are three or more taken together should greatly minimize developing resistance.

Why they relapse after stopping? Some don’t, but many do and the thinking is, AMAT sends MAP into dormancy. It doesn’t eradicate it, so it is basically another form of managing the disease, not curing. Once the threat of AMAT is no longer present, MAP awakes and continues to wreck havoc.
 
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