Presence of Infection by Mycobacterium avium subsp. paratuberculosis in the Blood of Patients with Crohn's Disease and Control Subjects Shown by Multiple Laboratory Culture and Antibody Methods.

J Todd Kuenstner,Xiaoning Lu,Tim J Bull,Antonio Foddai,Ira Shafran,Horacio Bach,Peilin Zhang,Irene R Grant,Daohai Yu,Raghava Potula,Saleh A Naser

doi:10.3390/microorganisms8122054

Abstract

Mycobacterium avium subspecies paratuberculosis (MAP) has long been suspected to be involved in the etiology of Crohn’s disease (CD). An obligate intracellular pathogen, MAP persists and influences host macrophages. The primary goals of this study were to test new rapid culture methods for MAP in human subjects and to assess the degree of viable culturable MAP bacteremia in CD patients compared to controls. A secondary goal was to compare the efficacy of three culture methods plus a phage assay and four antibody assays performed in separate laboratories, to detect MAP from the parallel samples. Culture and serological MAP testing was performed blind on whole blood samples obtained from 201 subjects including 61 CD patients (two of the patients with CD had concurrent ulcerative colitis (UC)) and 140 non-CD controls (14 patients in this group had UC only). Viable MAP bacteremia was detected in a significant number of study subjects across all groups. This included Pozzato culture (124/201 or 62% of all subjects, 35/61 or 57% of CD patients), Phage assay (113/201 or 56% of all subjects, 28/61 or 46% of CD patients), TiKa culture (64/201 or 32% of all subjects, 22/61 or 36% of CD patients) and MGIT culture (36/201 or 18% of all subjects, 15/61 or 25% of CD patients). A link between MAP detection and CD was observed with MGIT culture and one of the antibody methods (Hsp65) confirming previous studies. Other detection methods showed no association between any of the groups tested. Nine subjects with a positive Phage assay (4/9) or MAP culture (5/9) were again positive with the Phage assay one year later. This study highlights viable MAP bacteremia is widespread in the study population including CD patients, those with other autoimmune conditions and asymptomatic healthy subjects.

Highlights

Mycobacterium avium subspecies paratuberculosis (MAP) is accepted as the cause of Johne’sDisease (JD) [1], a chronic diarrheal wasting disease of cattle and a wasting disease in sheep and goats [2] and has long been suspected to be involved in the etiology of Crohn’s Disease (CD), an inflammatory bowel disease (IBD) of humans [3]
Viable MAP is present in our food, potable water and can be isolated from commercially available pasteurized milk [31,32] with MAP being identified in 2.7% of retail pasteurized milk samples purchased in Wisconsin, Minnesota and California, USA [31]
The median patient age and age ranges are presented in addition to the mean age and standard deviation because the data is asymmetric, and this approach is favored for asymmetric distributions such as age data

Summary

Introduction

Mycobacterium avium subspecies paratuberculosis (MAP) is accepted as the cause of Johne’sDisease (JD) [1], a chronic diarrheal wasting disease of cattle and a wasting disease in sheep and goats [2] and has long been suspected to be involved in the etiology of Crohn’s Disease (CD), an inflammatory bowel disease (IBD) of humans [3]. MAP and/or CD are associated with many other autoimmune diseases including multiple sclerosis (MS) [4,5,6,7,8,9,10,11,12,13], type I diabetes mellitus (T1DM). A diarrheal/wasting illness associated with infection with MAP has been reported in non-human primates [30]. Screening of human sera with a MAP specific antibody assay has found evidence of MAP specific immune recognition in subjects with a range of underlying diseases including patients with CD and asymptomatic controls [33]. Previous meta-analyses looking predominantly at molecular detection methods indicated a trend for studies showing a significantly higher percentage of MAP detection in samples from patients with

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