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Where are all the Mycobacterium avium subspecies paratuberculosis in patients with Crohn's disease?

Pierce ES - PLoS Pathog. (2009)

Bottom Line: Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic granulomatous inflammation of the intestines, Johne's disease, in dairy cows and every other species of mammal in which it has been identified.Large numbers of MAP might therefore be found in the mesentery attached to segments of intestine affected by Crohn's disease rather than in the bowel wall, the blood and lymphatic vessels running through the mesentery, or the mesenteric fat itself.The walls of fistulas might result from the neoangiogenesis or lymphangiogenesis that occurs in the bowel wall in Crohn's disease and therefore are also possible sites of large numbers of MAP.

View Article: PubMed Central - PubMed

Affiliation: Spokane Valley, Washington, USA. ellenpiercemd@gmail.com

ABSTRACT
Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic granulomatous inflammation of the intestines, Johne's disease, in dairy cows and every other species of mammal in which it has been identified. MAP has been identified in the mucosal layer and deeper bowel wall in patients with Crohn's disease by methods other than light microscopy, and by direct visualization in small numbers by light microscopy. MAP has not been accepted as the cause of Crohn's disease in part because it has not been seen under the microscope in large numbers in the intestines of patients with Crohn's disease. An analysis of the literature on the pathology of Crohn's disease and on possible MAP infection in Crohn's patients suggests that MAP might directly infect endothelial cells and adipocytes and cause them to proliferate, causing focal obstruction within already existing vessels (including granuloma formation), the development of new vessels (neoangiogenesis and lymphangiogenesis), and the "creeping fat" of the mesentery that is unique in human pathology to Crohn's disease but also occurs in bovine Johne's disease. Large numbers of MAP might therefore be found in the mesentery attached to segments of intestine affected by Crohn's disease rather than in the bowel wall, the blood and lymphatic vessels running through the mesentery, or the mesenteric fat itself. The walls of fistulas might result from the neoangiogenesis or lymphangiogenesis that occurs in the bowel wall in Crohn's disease and therefore are also possible sites of large numbers of MAP. The direct visualization of large numbers of MAP organisms in the tissues of patients with Crohn's disease will help establish that MAP causes Crohn's disease.

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Related in: MedlinePlus

This Photograph of “Obliterative Endarteritis” Illustrates the Diffuse Endothelial Cell Proliferation within Blood Vessels, Causing the Circumferential Widening of the Intima, in Contrast to the Focal Proliferation of Endothelial Cells within Lymphatics, Resulting in Granulomas.Large numbers of MAP organisms might be found within the endothelial cells of the thickened intima. Reprinted from Military Surgeon 1951, 109: 463–502, a publication of the Armed Forces Institute of Pathology, with the very kind assistance of Dr. Leslie Sobin [75].
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ppat-1000234-g003: This Photograph of “Obliterative Endarteritis” Illustrates the Diffuse Endothelial Cell Proliferation within Blood Vessels, Causing the Circumferential Widening of the Intima, in Contrast to the Focal Proliferation of Endothelial Cells within Lymphatics, Resulting in Granulomas.Large numbers of MAP organisms might be found within the endothelial cells of the thickened intima. Reprinted from Military Surgeon 1951, 109: 463–502, a publication of the Armed Forces Institute of Pathology, with the very kind assistance of Dr. Leslie Sobin [75].

Mentions: The literature suggests that the proliferation of lymphatic endothelial cells in Crohn's disease occurs primarily within already existing vessels and is focal or segmental (Figure 2) rather than diffuse or circumferential, causing granuloma formation that obstructs the vessel and lymphangiectasis, and only secondarily causing lymphangiogenesis. In contrast, the proliferation of vascular endothelial cells in Crohn's disease appears equally likely to cause both neoangiogenesis, the development of new blood vessels, and circumferential thickening of the intima within already existing blood vessels (Figure 3), but only occasional granuloma formation.


Where are all the Mycobacterium avium subspecies paratuberculosis in patients with Crohn's disease?

Pierce ES - PLoS Pathog. (2009)

This Photograph of “Obliterative Endarteritis” Illustrates the Diffuse Endothelial Cell Proliferation within Blood Vessels, Causing the Circumferential Widening of the Intima, in Contrast to the Focal Proliferation of Endothelial Cells within Lymphatics, Resulting in Granulomas.Large numbers of MAP organisms might be found within the endothelial cells of the thickened intima. Reprinted from Military Surgeon 1951, 109: 463–502, a publication of the Armed Forces Institute of Pathology, with the very kind assistance of Dr. Leslie Sobin [75].
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2654961&req=5

ppat-1000234-g003: This Photograph of “Obliterative Endarteritis” Illustrates the Diffuse Endothelial Cell Proliferation within Blood Vessels, Causing the Circumferential Widening of the Intima, in Contrast to the Focal Proliferation of Endothelial Cells within Lymphatics, Resulting in Granulomas.Large numbers of MAP organisms might be found within the endothelial cells of the thickened intima. Reprinted from Military Surgeon 1951, 109: 463–502, a publication of the Armed Forces Institute of Pathology, with the very kind assistance of Dr. Leslie Sobin [75].
Mentions: The literature suggests that the proliferation of lymphatic endothelial cells in Crohn's disease occurs primarily within already existing vessels and is focal or segmental (Figure 2) rather than diffuse or circumferential, causing granuloma formation that obstructs the vessel and lymphangiectasis, and only secondarily causing lymphangiogenesis. In contrast, the proliferation of vascular endothelial cells in Crohn's disease appears equally likely to cause both neoangiogenesis, the development of new blood vessels, and circumferential thickening of the intima within already existing blood vessels (Figure 3), but only occasional granuloma formation.

Bottom Line: Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic granulomatous inflammation of the intestines, Johne's disease, in dairy cows and every other species of mammal in which it has been identified.Large numbers of MAP might therefore be found in the mesentery attached to segments of intestine affected by Crohn's disease rather than in the bowel wall, the blood and lymphatic vessels running through the mesentery, or the mesenteric fat itself.The walls of fistulas might result from the neoangiogenesis or lymphangiogenesis that occurs in the bowel wall in Crohn's disease and therefore are also possible sites of large numbers of MAP.

View Article: PubMed Central - PubMed

Affiliation: Spokane Valley, Washington, USA. ellenpiercemd@gmail.com

ABSTRACT
Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic granulomatous inflammation of the intestines, Johne's disease, in dairy cows and every other species of mammal in which it has been identified. MAP has been identified in the mucosal layer and deeper bowel wall in patients with Crohn's disease by methods other than light microscopy, and by direct visualization in small numbers by light microscopy. MAP has not been accepted as the cause of Crohn's disease in part because it has not been seen under the microscope in large numbers in the intestines of patients with Crohn's disease. An analysis of the literature on the pathology of Crohn's disease and on possible MAP infection in Crohn's patients suggests that MAP might directly infect endothelial cells and adipocytes and cause them to proliferate, causing focal obstruction within already existing vessels (including granuloma formation), the development of new vessels (neoangiogenesis and lymphangiogenesis), and the "creeping fat" of the mesentery that is unique in human pathology to Crohn's disease but also occurs in bovine Johne's disease. Large numbers of MAP might therefore be found in the mesentery attached to segments of intestine affected by Crohn's disease rather than in the bowel wall, the blood and lymphatic vessels running through the mesentery, or the mesenteric fat itself. The walls of fistulas might result from the neoangiogenesis or lymphangiogenesis that occurs in the bowel wall in Crohn's disease and therefore are also possible sites of large numbers of MAP. The direct visualization of large numbers of MAP organisms in the tissues of patients with Crohn's disease will help establish that MAP causes Crohn's disease.

Show MeSH
Related in: MedlinePlus