Resources for physicians

The Marshall Protocol (MP) is the name given to a therapy devised by Professor Trevor Marshall. Based on the pathogenesis Marshall has proposed for chronic inflammatory disease, the MP is aimed at targeting bacteria, fungi, viruses, and other microbes that appear to interact to cause chronic inflammatory diseases.

Marshall (and colleagues) have hypothesized that chronic inflammatory diseases, including many autoimmune diseases, are caused by dysbiosis of a metagenomic microbiota: communities of microbial pathogens, many of which persist intracellularly. A recent peer-reviewed paper describes this Pathogenesis in more detail.¹

Supported by Autoimmunity Research Foundation, the MP has been available since 2002 and has been used in a wide range of chronic inflammatory illnesses.

A significant number of patients diagnosed with sarcoidosis, post-treatment chronic Lyme syndrome, chronic fatigue syndrome, uveitis, Hashimoto’s thyroiditis, rheumatoid arthritis, fibromyalgia, diabetes type II, psoriasis, lupus (SLE), multiple sclerosis, and a number of other diagnoses are showing a promising response from being treated with the Protocol.

In determining whether a patient can be successfully treated with the MP, a specific chronic disease diagnosis is not as important as the clinical assessment by a knowledgeable health care provider, the results of a therapeutic probe, and outcome of the vitamin D metabolites blood test.²

According to the Marshall Pathogenesis, chronic inflammatory disease is characterized by dysregulation of the nuclear receptor pathways which control the innate immune response. For example, the Vitamin D nuclear receptor (VDR) expresses many of the body's antimicrobial peptides (along with TLR2). In addition to down-regulation of expression of the VDR itself by many common bacteria and viruses, antagonistic microbial metabolites incrementally block ligands from activating it. Ingested vitamin D slows activity of the receptor in this same manner, preventing the body from killing the pathogens at the heart of the disease state. That is why avoidance of ingested vitamin D (in food and supplements) is essential for the innate immune system to function correctly while patients are on the MP.^{3 4}

The MP uses multiple daily dosing of olmesartan medoxomil (Benicar, Olmecip, Olmetec) to re-activate the Vitamin D Nuclear Receptor, dislodging bacterial ligands in the process. This drug was developed as an Angiotensin II Receptor Blocker (ARB) but it has multiple actions in the human body when dosed as defined by Marshall. In addition to immunostimulation via the VDR, Olmesartan also reduces inflammatory cytokine production by inhibiting the NF kappa-B transcription pathway. This inhibits, among other things, the release of TNF-alpha, helping to protect the organs from effects of excessive inflammation.

Additionally, several pulsed, low-dose, bacteriostatic oral antibiotics may be used to help a severely weakened immune system recognize the pathogens in the metagenomic microbiota. Five bacteriostatic antibiotics: minocycline, azithromycin (Zithromax), clindamycin, sulfamethoxazole-trimethoprim (Bactrim DS), and demeclocycline (Declomycin) have been found to help the immune system weaken and attack components of the systemic microbiota. Minocycline additionally directly acts in an immunosuppressive manner on the PXR nuclear receptor, and this biochemical action may be useful in pulsing immunopathology to (for example) a 48 hour cycle.

Seriously ill patients may develop photosensitivity during the healing process, so avoidance of direct and indirect sunlight may be necessary. Patients may need to protect their eyes from bright lights to prevent further retinal damage and reduce neurological symptoms due to inter alia, the effect of ocular 1,25-D production on the brain.

Patients may also develop sensitivity to skin exposure to sunlight, and/or find that they need to avoid skin exposure to sunlight in order to maintain the low blood levels of vitamin D required by the Protocol. However, some patients do not experience significant photosensitivity during recovery, and those who do often find it more manageable several years into the therapy.

Trevor Marshall and the rest of the Autoimmunity Research Foundation research team have been active in publishing papers and making presentations before learned bodies.

Marshall's recent presentations can be viewed in order to get a more detailed description of the Marshall Pathogenesis and Protocol.

The Autoimmunity Research Foundation will help physicians and other health care providers understand Th1 inflammatory diseases and the MP, but the responsibility for managing the patient’s health and recovery resides with the licensed practitioner. The information on this site is intended to be a guideline for that health care provider.

Access to the Marshall Protocol study site is available for health professionals upon request. Health Professionals are welcome, and will be manually joined into the database after sending an email to Moderators@MarshallProtocol.com listing their desired username and password. Health professionals are granted access to the Private Section for Health Professionals.

In addition to the Private Section for Health Professionals, health professionals have the option to contact Dr. Marshall at TM@AutoimmunityResearch.org or (818) 584-1201.

To ensure success, physicians are asked to encourage their patients to carefully study this Knowledge Base. This site provides additional instructions, helpful hints, and support that will greatly ease a practitioner’s emotional support workload and smooth the patient’s path to recovery.