title: On the effect of thalidomide on Mycobacterium avium subspecies paratuberculosis in culture.
abstract: BACKGROUND
  Without known mechanisms of action, thalidomide is used to treat a variety of non-malignant 'idiopathic' diseases. There is increasing concern that Mycobacterium avium subspecies paratuberculosis (MAP) may be zoonotic. Recently, methotrexate, azathioprine, 6-mercaptopurine (6-MP), 5-aminosalicylic acid (5-ASA), cyclosporine A, rapamycin, and tacrolimus have been shown to inhibit MAP growth in culture, indicating that, unknowingly, MAP infections may have been treated for decades. We herein test the hypothesis that thalidomide may inhibit MAP growth.
  
  
  METHODS
  Using the radiometric 14CO2 (Bactec) system we quantified growth kinetics of thalidomide (+/-), (+), and (-) and two components for thalidomide, phthalimide and 1-hydroxypiperidine-2,6-dione (HPD). We studied four MAP strains (three human isolates, 'Ben', 'Dominic', and UCF-4, and a bovine MAP isolate 19698) and three mycobacterial controls (Mycobacterium avium and bacillus Calmette-Guérin (BCG)). Growth was quantified as growth index (GI) and inhibition as percent decrease in cumulative GI (%-DeltacGI).
  
  
  RESULTS
  Phthalimide had no dose-dependent inhibition on any strain. Neither thalidomide nor HPD inhibited M. avium or BCG. MAP inhibition varied; at 64 microg/ml, amongst human isolates, Dominic was most susceptible: thalidomide (+)=58%-DeltacGI and HPD=46%-DeltacGI. UCF-4 was next: thalidomide (-)=37%-DeltacGI and HPD=40%-DeltacGI. Ben was least susceptible: HPD=24%-DeltacGI.
  
  
  CONCLUSIONS
  We have shown, in culture, the heretofore-undescribed inhibition of MAP growth by thalidomide and its enantiomers. Phthalimide was found to have no anti-MAP activity, whereas HPD was found to inhibit MAP growth. These data are compatible with the hypothesis that thalidomide, like other 'anti-inflammatories' and 'immunomodulators' may act, in part, as an anti-MAP antibiotic.
authors.affiliation: VAMC Bronx NY (112), 130 West Kingsbridge Rd, Bronx, NY 10468, USA. BGAxis@aol.com
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Greenstein
authors.forename: Liya
authors.initials: L
authors.lastname: Su
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
mesh_terms: D000818:Animals; D001431:Bacteriological Techniques; D002417:Cattle; D003470:Culture Media; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016927:Mycobacterium avium subsp. paratuberculosis / Q000187:drug effects* / Q000254:growth & development*; D010797:Phthalimides / Q000494:pharmacology; D010880:Piperidines / Q000494:pharmacology; D013792:Thalidomide / Q000494:pharmacology*
chemical_list: D003470:Culture Media; D007166:Immunosuppressive Agents; D010797:Phthalimides; D010880:Piperidines; C062320:N-hydroxypiperidine; D013792:Thalidomide