That doesn't mean 6MP or TNF blockers are a good way to stop a pathogen though, it's just that they see it's stopping MAP (maybe on an insignificant level though), they see this in almost all successful crohn medications. But coming off the medication and the long term use of medication might actually end up helping MAP
Immune modulators like 6MP and TNF blockers could be making the disease both better and worse, the paradox that an immunesuppressant might actually stop a pathogen in the short term but help in the long term QUOTE]
kiny - I've read or watched on youtube about how immune modulating/tnf drugs can induce apoptosis and I guess kill some of the map in the process. However, I've not read or watched on youtube any comment that long-term use of these drugs can benefit the map bug over time. This in contrast to what I've read about the use of antibiotics, which may enable map to become resistant to the drugs. Have you read/watched anything that actually suggests what you said, namely that immune-modulating drugs show some tendency to strenghten the map's virulence over time?
Also, do you have a feel for what the current status is for the development of a map-testing kit, as well as the status for the development and testing of a map-vaccine? I noted that John Hermon-Taylor seems to be working on both of these items in London, England. I've seen him on some web sites where he periodically posts a tiny little blurb, nothing really substantial, but he says he's working on these things, getting very close, and asking for financial donations from anyone who will give. Is he for real? Do you know whether his efforts are indeed close or sound?
(I assume MAP is causative in crohn for discussion sake then)
http://www.ncbi.nlm.nih.gov/pubmed/16503465
"Defective acute inflammation in Crohn's disease: a clinical investigation.
Department of Medicine, University College London, London WC1E 6JJ, UK.
In Crohn's disease, a constitutionally weak immune response predisposes to accumulation of intestinal contents that breach the mucosal barrier of the bowel wall, resulting in granuloma formation and chronic inflammation. Polymorphisms in CARD15 do not underlie this phenotype, but incapacitate the NOD2 pathway that can compensate for impairment of innate inflammation. Current treatment of secondary chronic inflammation might exaggerate the underlying lesion and promote chronic disease."
This study says that treating the secondary effect of crohn might make it eventually worse because it's just targeting the inflammation, not the cause of the inflammation. And if crohn is an infection, lowering the immune system does really not seem like a smart idea.
But when they do tests with 6MP in vitro and infliximab in vivo (the ones I linked) MAP does not increase, it's pretty stable for 6MP and in infliximab it goes down (at least in the first 24 hours, then it levels out and equals controls with MAP (some controls without CD have MAP too)). At least in the short term. But because MAP is so hard to detect and knowing how prevelant MAP is in a person seems really hard I also wonder how accurate those studies are.
(that MAP lowers within the first 24 hours of TNF-blocker use, is just one single study, and they did not check what happens after that iirc)
But with tuberculosis, also a mycobacteria, this doesn't happen at all, tuberculosis goes out of control really fast with a TNF-a blocker, it reproduces very fast if you use a TNF-a blocker, that's why they do that mantoux test and many clinics also do an Xray of your chest to make sure you don't have TB, before they use it. You can't start a TNF-blocker before they check this for that reason.
But with MAP this doesn't happen. Why, I don't know, MAP first of all reproduces much much slower than TB, if MAP does increase you wouldn't be able to tell very well, but like you said, 6MP and TNF-blockers are apparently able to induce apoptosis. I don't know what the end result would be, would apoptosis of macrophages be enough to stop the spread of MAP, but why then do people not improve in the long term, take someone off a TNF blocker and many get sick pretty fast again, some get long term remission, but many do not, so if MAP is causative, apoptosis in those first 24 hours after you get infliximab doesn't seem to have a lasting effect.
This is what I read, I think they don't know what the effect is, on the one hand they see apoptosis, but on the other hand some studies warn of long term effects.