Crohn’s disease

is a chronic inflammatory process predominantly involving the gastrointestinal tracts. It is also called inflammatory bowel disease. The cardinal symptom of Crohn’s is a chronic diarrhea with abdominal pain and cramping. The disease varies from mild to severe and the diagnosis of Crohn’s disease relies on clinical assessment and the biopsy studies of the tissue from the intestinal tract.

The etiology of Crohn’s disease is unknown, and it is considered by medical professionals an autoimmune disease (your body generates antibodies against your own tissue). Like many other autoimmune diseases, there is no cure for Crohn’s disease, and the treatment option is to suppress the immune system using immunosuppressive agents.

MAP and other medical conditions

There is a large body of medical literature in the past 30 years regarding Crohn’s disease and mycobacteria infection (Mycobacteria alvium subspecies Paratuberculosis, MAP). The debate in medical field is still raging whether there is a causal effect of MAP on Crohn’s disease. The fact is that in nearly 50% Crohn’s patients, a blood culture is positive for MAP (this means you have a strain of mycobacteria in your blood). If you are a Crohn’s patient, there is 50% chance that you are carrying MAP in your blood. It is ironic today that the standard care of Crohn’s disease does not include the treatment of MAP. There are various reports and clinical trial data indicating treatment of MAP infection results in lasting remission of Crohn’s disease.

In addition to Crohn’s disease, there are approximately 20% patients with ulcerative colitis positive for MAP in blood culture too. There are many medical reports regarding association of MAP with type I diabetes, multiple sclerosis and Parkinson’s disease. Treatment of MAP with antibiotics, if culture positive, could prove to be the essential step in treatment of these diseases.

Interestingly, there are no commercial medical laboratories performing the tests for MAP. We are the first commercial testing laboratory to conduct the testing for human diseases.

How to test the presence of MAP? Why blood culture?
What about serology? PCR (molecular testing)?

We offer three separate tests to identify MAP in the blood, blood culture (to grow MAP from
peripheral blood), serology (to determine if there are antibodies in the circulation against MAP) or by
molecular amplification of DNA from the mycobacteria by PCR/sequencing. Each method has
advantages and disadvantages in clinical setting to answer the same question from different aspects,
and they are elaborated as the following.

Blood culture

Blood culture of MAP is the gold standard for determination of active MAP infection, and it is ideal to have a blood culture result before treatment. Culture of MAP is a tedious and expensive process, and it takes 4-12 weeks to get results, since MAP is a slow grower with special requirements to grow. There is no commercial laboratory available to perform this test to date, and that’s why we are here to help.

Serology testing

Once the patient is infected by MAP, the patient’s body will react to the mycobacteria by generating specific antibody against MAP, and the determination of the antibody against MAP will provide an important information. However, the antibody determination is not sensitive (varies from 40-70% based on animal studies). In another word, if the antibody test is negative, the patient could still be infected.

Molecular testing by PCR/sequencing

PCR testing is a fast and accurate method to determine the presence of MAP DNA in blood. In conjunction with DNA sequencing, it will provide accurate assessment of MAP DNA in the body. However, just like any other PCR test, it is testing the presence of DNA, not living mycobacterial organisms. It does not say if the mycobacteria are alive, or dead. It is a wonderful complimentary test to culture and serology.