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lean water and pasteurization are adopted, the prevalence of H. pylori infection has declined. On the one hand, this has been accompanied by a drop in the incidence of gastric cancer and ulcers. On the other, there has been an increase in esophageal cancer. H. pylori appear to protect against cancer of the esophagus. "So that says that there might be something about persistent infection that might be protective," said Falkow.

This raises the conundrum: By messing with the microbes, are we just replacing one disease with another?

Falkow's lab has been studying the phenomenon of persistent infection for decades, in particular with H. pylori and Salmonella. He and his colleagues have shown that when infected with these organisms, mice initially show an inflammatory response that then settles down and stays with them for the rest of their lives.

Although very few of these organisms remain in the mice, it is enough to cause the immune system to have an ongoing response. "It's not so much that the immune system has failed," Falkow explained, "but that the organisms have manipulated the immune system in such a way that they can't be cleared." If the infections are cleared by antibiotic intervention, the mice are highly susceptible to re-infection, and the re-infection is more likely to progress to disease than the initial infection.

Furthermore, as many infectious diseases have decreased, autoimmune diseases such as ulcerative colitis, Crohn's disease and diabetes have increased.

"All these observations have been made without necessarily trying to pull it all together," said Falkow. "So what I tried to do in this article is to point out that the continued presence of these organisms in human society may actually be beneficial to the host and that is why they are tolerated by the immune system."

It's an intriguing idea that requires more research in animal models. "We don't know what to look for per se," he said. "But we can g
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Source:Stanford University


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