Possible Cause
The cause of Crohn's disease has been unknown since the disease was named by Dr. Berle Crohn in 1932.  This “diagnosis” known as Crohn's disease is confirmed by clinical and x-ray characteristics.  The most common location for this disease is the small intestine (ileum) where inflammation occurs to thicken the bowel wall and eventually cause narrowing of the lumen.  Over time, progression of this narrowing can occur and result in obstruction.  The disease can also form tracks (fistulae) as a result of tiny perforations in the bowel which communicate from one to another. 

Our recent studies have shown an association with a bacteria known as Mycobacterium avium ss. paratuberculosis (MAP), which has been found to infect ruminants (cattle, sheep, goats, deer... etc) and primates (apes, monkeys.. etc). 

It is our belief that those people genetically at risk for a bacterial subset of Crohn's disease are exposed to certain bacteria and thus acquire an infection.  This infection is believed to trigger an exaggerated immune response causing such symptoms as acute diarrhea, abdominal pain, and the development of  ulcers of the small and large bowel and ultimately, recurrent episodes of damage to the small and large intestine.

Conventional Treatments
Currently, all we have are “Band-Aid” approaches to treating this disease. None of our current therapies offer a cure. In the past, patients have been treated with corticosteroids (Prednisone) and anti-inflammatory drugs, which have been shown to be beneficial for inducing remission in this disease.  Unfortunately, corticosteroid medications have numerous side effects, including profound weight gain, swollen face (cushingoid facies), elevation of blood sugar, hypertension, thinning of bones, cataract formation, mood swings, and a myriad of other side effects.  Although the anti-inflammatory therapies appear to be safe, they are not always effective in putting this disease into remission. 

Newer therapies directed at blocking the immune reaction to the cause of this disease are interesting and include 6-Mercaptopurine (Imuran) and a new product, Remicade anti-tumor necrosis factor.  These drugs block the immune response and in my opinion, are of unproven safety at this time since they have not been on the market long enough.  In some patients who are unresponsive to the traditional Crohn's therapies, these particular medications have proven useful.  Their long term safety and efficacy, however; need to be studied further. 

MAP
Our study focuses on a specific bacteria known as Mycobacterium avium ss. paratuberculosis (MAP), a microorganism, which we believe may be the cause of disease for some patients with Crohn's.  This bacteria in its invasive form is thought to invade the intestinal wall by losing its cell wall.  The cell wall is the part of the bacteria that allows identification by conventional methods.  Since this cell wall-less form or spheroplast is difficult to detect, we are developing new, more novel methods to identify it.In addition, we are currently attempting to demonstrate the presence of this bacteria in Crohn's patients by looking for the unique DNA characteristics of this bacteria. We are also trying to determine the bacteria's response to different forms of treatment. 

DNA fingerprinting is possible by obtaining tissue and doing what is called PCR (Polymerase Chain Reaction) to look for the very characteristic molecular configuration of this bacteria.  We are also attempting to visualize the bacteria utilizing a confocal laser scanning microscope, where we can hopefully identify the bacteria in active disease tissue.  All of these investigations are underway at this time. 

With future findings of the human genome project and chromosomal studies in families with inflammatory bowel disease, it will be possible to predict who is genetically at risk for this disease and if MAP is indeed involved. If this is proven then the elimination of this human pathogen will be necessary to reduce the incidence of this disease.  If this bacteria is ever proven to be found in dairy products as well as any other sources, ultrapasteurization and other preventive measures will need to be required to eradicate this type of bacteria (MAP) in addition to Listeria monocytogenes, Yersenia enterocolitis, which are all significant human pathogens. 

RMAT
Dr. John Hermon-Taylor, chief of surgery at St. George's Hospital in London, England, was one of the first to advocate the use of Rifabutin and Clarithromycin in the treatment of Crohn's disease.   Here in the U.S., our studies have shown in an open trial of approximately 42 patients, a documented response and wellness. We have also seen improvement in laboratory parameters as well as demonstrated endoscopic healing.   We intend to confirm improvement by correlating it with the eradication of this bacteria and, in the future, through serologic (blood) and microscopic testing.  We are also in the process of attempting to develop a quantitative method for measuring the amount of bacteria in the system.

Although we are still in the preliminary stages of our 6 to 24 month clinical trial of RMAT (Rifabutin and macrolide antibiotic therapy), the positive response of many of my patients has further demonstrated to me that bacteria such as Mycobacterium paratuberculosis play an integral role as the cause of this disease in a large subset of Crohn's patients.

I encourage you to share this information with your current physician. If your physician would like more information about Mycobacterium paratuberculosis and its association with Crohn's or would like to learn more about RMAT therapy, please print the Physician's Information Packet. 

By sharing these discoveries, we can work together to make it possible for Crohn's patients to benefit from the latest research and to choose a therapy that is suited for their specific disease manifestation. 

The information contained in this site is intended for information purposes only and is not intended as a means of diagnosing or treating disease. Please consult your doctor before starting any treatment.