Resources for physicians

The Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) is the name given to a therapy devised by Professor Trevor Marshall, and is based on the pathogenesis he has elucidated for chronic disease.

Marshall (and colleagues) observed that chronic inflammatory diseases, including many autoimmune diseases, are caused by a metagenomic microbiotaThe community of bacterial pathogens including those in an intracellular and biofilm state which cause chronic disease.: communities of bacterial pathogens, many of which persist intracellularly. A recent peer-reviewed paper describes this Pathogenesis in more detail.¹

The Marshall Protocol, a medical treatment supported by Autoimmunity Research FoundationNon-profit foundation dedicated to exploring a pathogenesis and therapy for chronic disease., has been available since 2002 and has applicability to 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, 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 PathogenesisA description for how chronic inflammatory diseases originate and develop., chronic inflammatory disease is characterized by dysregulation of the nuclear receptorIntracellular receptor proteins that bind to hydrophobic signal molecules (such as steroid and thyroid hormones) or intracellular metabolites and are thus activated to bind to specific DNA sequences which affects transcription. pathways which control the innate immune responseThe body's first line of defense against intracellular and other pathogens. According to the Marshall Pathogenesis the innate immune system becomes disabled as patients develop chronic disease.. The Vitamin D nuclear receptor (VDRThe Vitamin D Receptor. A nuclear receptor located throughout the body that plays a key role in the innate immune response.) expresses many of the body's antimicrobial peptidesBody’s naturally produced broad-spectrum antibacterials which target pathogens. (along with TLR2a receptor which is expressed on the surface of certain cells and recognizes native or foreign substances and passes on appropriate signals to the cell and/or the nervous system.). In addition to down-regulation of expression of the VDR itself by many common pathogens, antagonistic bacterial 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 four-times daily dosing of the ARB olmesartan medoxomil (Benicar, Olmecip, Olmetec) to re-activate the Vitamin D Nuclear Receptor, dislodging bacterial ligands in the process. Additionally, several pulsed, low-dose, bacteriostatic oral antibiotics are used to help the immune system recognize the pathogens in the metagenomic microbiota. Olmesartan also reduces inflammatory cytokineAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. 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 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue..

Patients on the MP ultimately will use up to five bacteriostatic antibiotics: minocyclineBacteriostatic antibiotic used by Marshall Protocol patients., azithromycin (Zithromax)Bacteriostatic antibiotic used by Marshall Protocol patients. Has relatively long half-life., clindamycinBacteriostatic antibiotic used by patients on the Marshall Protocol. , sulfamethoxazole-trimethoprim (Bactrim DSSulfa antibiotic used by patients on the Marshall Protocol. Combination of sulfamethoxazole and trimethoprim. Works by blocking bacterial folic acid synthesis.), and demeclocycline (Declomycin)Bacteriostatic antibiotic used by patients on the Marshall Protocol. to help their immune system weaken and attack components of the systemic microbiotaThe bacterial community which causes chronic diseases - one which almost certainly includes multiple species and bacterial forms..

Seriously ill patients may develop photosensitivityAbnormal sensitivity to sunlight and bright lights. Also referred to as "sun flare" or "light flare." 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-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol. production on the brain. Some patients do not experience any significant photosensitivity during recovery, and those who do often find it more manageable after 12 to 18 months.

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 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.