Gastroenterology

Gastroenterology

Volume 115, Issue 6, December 1998, Pages 1405-1413
Gastroenterology

Alimentary Tract
Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn's disease,☆☆

https://doi.org/10.1016/S0016-5085(98)70019-8Get rights and content

Abstract

Background & Aims: Infectious agents are suspected of being involved in the pathogenesis of Crohn's disease. This study was designed to look for the presence of virulent Escherichia coli strains associated with the ileal mucosa of patients with Crohn's disease. Methods: E. coli strains were recovered from resected chronic ileal lesions (n = 20), neoterminal ileum after surgery from patients with (n = 19) and without (n = 11) endoscopic recurrence, and controls (n = 13). Bacterial adhesion was determined in vitro using intestinal cell lines; other associated virulence factors were assessed by DNA hybridization and polymerase chain reaction experiments. Results: None of the strains harbored any of the virulence factor–encoding genes of E. coli involved in acute enteric diseases. However, mannose-resistant adhesion to differentiated Caco-2 cells was found for 84.6% and 78.9% of the E. coli strains isolated from chronic and early recurrent lesions, respectively, compared with 33% of controls (P < 0.02). In addition, 21.8% of the strains induced a cytolytic effect by synthesis of an α-hemolysin. Conclusions: E. coli strains isolated from the ileal mucosa of patients with Crohn's disease adhere to differentiated intestinal cells and may disrupt the intestinal barrier by synthesizing an α-hemolysin.

GASTROENTEROLOGY 1998;115:1405-1413

Section snippets

Patients

Sixty-three mucosal specimens were studied, 50 from patients with CD and 13 from controls.

Quantification of E. coli strains in ileal mucosa

E. coli strains were isolated from 13 (65%) of the 20 biopsy specimens of chronic ileal lesions in patients with CD. Similar percentages were obtained from healthy ileal mucosa of patients with CD (64%) and controls (69%). This percentage reached 100% in the early ileal lesions of the 19 patients who had endoscopic recurrence. To estimate the colonization of the ileal mucosa by E. coli, we determined the percentage of E. coli in the total bacteria present in the specimens. E. coli was

Discussion

Various studies have addressed the hypothesis that virulent or adherent E. coli contributes to the pathogenesis of inflammatory bowel disease in an unexplained manner.19, 20, 21, 22 Conflicting results were obtained, possibly because the strains analyzed were isolated from feces or rectal biopsy specimens. In the present study, to our knowledge the first one of its type, we assessed the prominence and virulence of E. coli strains associated with the ileal mucosa, the most important site of CD.

Acknowledgements

The authors thank Michael Donnenberg for providing plasmid pCVD434, Myron M. Levine for the EAggEC strain 17-2 and plasmid pCVD432, Inga Benz for plasmid pIB6, James Nataro for plasmid pJPN16, and Steve Moseley for plasmids pEWD299 and pSLM852 and the E. coli strain C1845. They also thank Chantal Le Bouguenec for providing the recombinant plasmids pILL22, pILL1019, pILL61; Chantal Rich and Agnès Couteau for excellent technical assistance; Christophe De Champs for statistical analysis of the

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    Address requests for reprints to: Arlette Darfeuille-Michaud, Ph.D., Laboratoire de Bactériologie, Faculté de Pharmacie, 28 Place Henri Dunant, 63001 Clermont-Ferrand Cedex, France. Fax: (33) 4-7327-7494; e-mail: [email protected].

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    Supported by grants from the Association F. Aupetit, the Fonds de Recherche de la Société Nationale Française de Gastro-Entérologie, the Centre Hospitalier Régional Universitaire de Lille (contract 96/38/9713), the Ministère de la Recherche et de la Technologie (EA522), and INSERM CRI 4U004B.

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