Our group is studying the effect of immunotherapy in patients serologically positive for Mycobacterium avium paratuberculosis. Our preliminary results show the elimination of antibody markers after treatment with infliximab in patients known previously positive. The loss of humoral antibody as a result of infliximab and the known protective role of TNF in the recruitment of macrophages may in fact be harmful to those patients with underlying bacterial infection. The identification of these patients and eradication of infection prior to using immunotherapy may prove safer for these patients. We are currently studying serology and its role in selecting the best therapy for these patients.
Further work is needed to evaluate the role of microbes in inflammatory bowel disease.
Animal models of IL 10 knockout mice, using artificial methods to induce colitis shed little information on human Crohn's disease, where these models may not explain the complex interactions of microbes and the human intestine. The role of bacteria, the balance between harmless commensals and potential pathogens should be studied using molecular diagnostic techniques. Antibiotic treatment has not been sufficiently studied in large multicentered double blind studies. The opportunity to understand the cause of Crohn's disease has never been so exciting.