Role of Klebsiella and collagens in Crohn's disease: a new prospect in the use of low-starch diet

Crohn's disease is suggested to result from a microbially triggered immune-mediated autoimmune process, involving mainly the terminal ileum and ileo-caecal junction. Klebsiella pneumoniae shares certain molecular structures present in pullulanase pulA and pulD secretion enzymes with various self-antigens present in collagens and HLA-B27 molecules, respectively. A link exists between high dietary starch intake and the growth of intestinal microflora, involving especially Klebsiella microbes. Increased exposure to Klebsiella in the gut as the result of high starch intake would lead to high production of antiKlebsiella antibodies as well as autoantibodies to the cross-reactive self-antigens with the resultant inflammation at the pathological sites. Eradication of these microbes from the gut in patients with Crohn's disease with the use of low-starch diet and antibacterial agents as well as immunomodulatory measures could be beneficial in the management of this disease.

[1]  I. Lawrance,et al.  Relationship between disease severity, quality of life and health‐care resource use in a cross‐section of Australian patients with Crohn's disease , 2007, Journal of gastroenterology and hepatology.

[2]  N. Read,et al.  Is the diarrhoea in ulcerative colitis related to impaired colonic salvage of carbohydrate? , 1987, Gut.

[3]  R. Diegelmann,et al.  Transforming growth factor beta 1 selectively augments collagen synthesis by human intestinal smooth muscle cells. , 1990, Gastroenterology.

[4]  S. Ukabam,et al.  Abnormal small intestinal permeability to sugars in patients with Crohn's disease of the terminal ileum and colon. , 1983, Digestion.

[5]  A. Akobeng,et al.  Systematic review: tolerable amount of gluten for people with coeliac disease , 2008, Alimentary pharmacology & therapeutics.

[6]  J. Cosnes,et al.  Colites intercurrentes à Klebsiella oxytoca au cours de la maladie de Crohn , 2002 .

[7]  J. Rotter,et al.  Increased intestinal permeability in patients with Crohn's disease and their relatives. A possible etiologic factor. , 1986, Annals of internal medicine.

[8]  H. Zeidler,et al.  HLA antigens in ankylosing spondylitis associated with Crohn's disease. Increased frequency of the HLA phenotype B27,B44. , 1988, The Journal of rheumatology.

[9]  H. Drummond,et al.  Contribution of the NOD1/CARD4 insertion/deletion polymorphism +32656 to inflammatory bowel disease in Northern Europe# , 2007, Inflammatory bowel diseases.

[10]  A. Sonnenberg,et al.  Periodicity of hospital admissions for inflammatory bowel disease. , 1994, The American journal of gastroenterology.

[11]  R. Diegelmann,et al.  Transforming growth factor beta 1 selectively augments collagen synthesis by human intestinal smooth muscle cells. , 1990, Gastroenterology.

[12]  L. Romics,et al.  Low levels of antibodies against E. coli and mycobacterial 65kDa heat shock proteins in patients with inflammatory bowel disease , 2004, Inflammation Research.

[13]  S. Finegold,et al.  Fecal microbial flora in Seventh Day Adventist populations and control subjects. , 1977, The American journal of clinical nutrition.

[14]  J. H. Kim,et al.  Clinical significance of anti-Saccharomyces cerevisiae antibody (ASCA) in Korean patients with Crohn's disease and its relationship to the disease clinical course. , 2007, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[15]  N. Koide,et al.  Experimental Murine Model for Autoimmune Enterocolitis Using Klebsiella pneumoniae O3 Lipopolysaccharide as a Potent Immunological Adjuvant , 1999, Microbiology and immunology.

[16]  W. Sandborn,et al.  Epidemiology of inflammatory bowel disease. , 2002, Gastroenterology clinics of North America.

[17]  E. Kuipers,et al.  CARD15 mutations in Dutch familial and sporadic inflammatory bowel disease and an overview of European studies , 2007, European journal of gastroenterology & hepatology.

[18]  D. Franchimont,et al.  Crohn's Disease , 1976, The Lancet.

[19]  A. Wakefield,et al.  Antibody responses to gut bacteria in ankylosing spondylitis, rheumatoid arthritis, Crohn's disease and ulcerative colitis , 1997, Rheumatology International.

[20]  R. Pounder,et al.  Absence of Escherichia coli, Listeria monocytogenes, and Klebsiella pneumoniae antigens within inflammatory bowel disease tissues. , 1998, Journal of clinical pathology.

[21]  A. Binder,et al.  Cytotoxicity responses to peptide antigens in rheumatoid arthritis and ankylosing spondylitis. , 2003, The Journal of rheumatology.

[22]  J. Brostoff,et al.  Food Allergy and Intolerance , 1980, The Lancet.

[23]  J. Mayberry,et al.  Epidemiological aspects of Crohn's disease: a review of the literature. , 1984, Gut.

[24]  H. Kandil,et al.  Nutritional factors in inflammatory bowel disease. , 2002, Gastroenterology clinics of North America.

[25]  A. Ebringer,et al.  A possible link between Crohn’s disease and ankylosing spondylitis via Klebsiella infections , 2007, Clinical Rheumatology.

[26]  A. Gebert,et al.  Luminal antigens access late endosomes of intestinal epithelial cells enriched in MHC I and MHC II molecules: in vivo study in Crohn's ileitis. , 2007, American journal of physiology. Gastrointestinal and liver physiology.

[27]  M. Levitt,et al.  Incomplete absorption of the carbohydrate in all-purpose wheat flour. , 1981, The New England journal of medicine.

[28]  P. Ciclitira,et al.  Characterization of the humoral immune response to Klebsiella species in inflammatory bowel disease and ankylosing spondylitis. , 1998, British journal of rheumatology.

[29]  R. Russell,et al.  Intestinal permeability in patients with Crohn's disease and their first-degree relatives. , 1994, The American journal of gastroenterology.

[30]  R Balfour Sartor,et al.  Microbial influences in inflammatory bowel diseases. , 2008, Gastroenterology.

[31]  R. Hammer,et al.  Susceptibility to inflammatory disease in HLA-B27 transgenic rat lines correlates with the level of B27 expression. , 1993, Journal of immunology.

[32]  Z. Fireman,et al.  Epidemiology of Crohn's disease in the Jewish population of central Israel, 1970-1980. , 1989, The American journal of gastroenterology.

[33]  R. Allan,et al.  Serological studies in Crohn's disease , 1987, European Journal of Clinical Microbiology.

[34]  Mark Feldman,et al.  Sleisenger and Fordtran's gastrointestinal and liver disease , 2012 .

[35]  E. Lindberg,et al.  Inflammatory bowel disease in a Swedish twin cohort: a long-term follow-up of concordance and clinical characteristics. , 2003, Gastroenterology.

[36]  W. Bilker,et al.  Seasonal variation in flares of inflammatory bowel disease. , 2004, Gastroenterology.

[37]  P. Schwimmbeck,et al.  Autoantibodies to HLA B27 in the sera of HLA B27 patients with ankylosing spondylitis and Reiter's syndrome. Molecular mimicry with Klebsiella pneumoniae as potential mechanism of autoimmune disease , 1987, The Journal of experimental medicine.

[38]  G. Schröter,et al.  Frequency and Spectrum of Microorganisms Isolated from Biopsy Specimens in Chronic Colitis , 1991, Endoscopy.

[39]  A. Ekbom,et al.  Appendectomy is followed by increased risk of Crohn's disease. , 2003, Gastroenterology.

[40]  Anders Ekbom,et al.  Epidemiology of inflammatory bowel disease. , 1999, Nestle Nutrition workshop series. Clinical & performance programme.

[41]  Hunter Jo.  Nutritional factors in inflammatory bowel disease. , 1998 .

[42]  A. Ebringer,et al.  Correlation between the immune responses to collagens type I, III, IV and V and Klebsiella pneumoniae in patients with Crohn's disease and ankylosing spondylitis. , 2001, Rheumatology.

[43]  D. Coppola,et al.  CMV Colitis Mimicking Recurrent Inflammatory Bowel Disease: Report of Three Cases , 2007, The American surgeon.

[44]  J. Braun,et al.  Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. , 1998, Arthritis and rheumatism.

[45]  A. Macpherson,et al.  Intestinal permeability: an overview. , 1995, Gastroenterology.

[46]  M. Egger,et al.  Mycobacterium avium subspecies paratuberculosis and Crohn's disease: a systematic review and meta-analysis. , 2007, The Lancet. Infectious diseases.

[47]  G. Verbeke,et al.  Clustering of increased small intestinal permeability in families with Crohn's disease. , 1997, Gastroenterology.

[48]  W. Sandborn,et al.  Inflammatory bowel disease: clinical aspects and established and evolving therapies , 2007, The Lancet.

[49]  Douglas R. Morgan,et al.  Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management , 1998 .

[50]  Zhibin Gao,et al.  Crohn's disease in mainland China: a systematic analysis of 50 years of research. , 2005, Chinese journal of digestive diseases.

[51]  F. Cominelli,et al.  Immunopathogenesis of inflammatory bowel disease: current concepts , 2007, Current opinion in gastroenterology.

[52]  M. Vatn,et al.  Relationship between sick leave, unemployment, disability, and health‐related quality of life in patients with inflammatory bowel disease , 2006, Inflammatory bowel diseases.

[53]  B. V. Pedersen,et al.  The risk of developing Crohn’s disease after an appendectomy: a population-based cohort study in Sweden and Denmark , 2007, Gut.

[54]  J. Aisenberg,et al.  Cluster of Inflammatory Bowel Disease in Three Close College Friends? , 1993, Journal of clinical gastroenterology.

[55]  R. E. Cowan,et al.  Treatment of active Crohn's disease by exclusion diet: East Anglian Multicentre Controlled Trial , 1993, The Lancet.

[56]  J. Reveille,et al.  Spondyloarthritis: update on pathogenesis and management. , 2005, The American journal of medicine.

[57]  W. V. Guimarães,et al.  Fermentation of starch by Klebsiella oxytoca p2, containing plasmids with alpha-amylase and pullulanase genes. , 1999, Biotechnology and bioengineering.

[58]  J. Genschel,et al.  Genetic basis for increased intestinal permeability in families with Crohn’s disease: role of CARD15 3020insC mutation? , 2005, Gut.

[59]  S. Fisher,et al.  Diverse effects of the CARD15 and IBD5 loci on clinical phenotype in 630 patients with Crohn's disease , 2008, European journal of gastroenterology & hepatology.

[60]  J. Rhodes,et al.  The role of Escherichia coli in inflammatory bowel disease , 2007, Gut.

[61]  W. Selby,et al.  Two-year combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for Crohn's disease. , 2007, Gastroenterology.

[62]  Judy H. Cho,et al.  The genetics and immunopathogenesis of inflammatory bowel disease , 2008, Nature Reviews Immunology.

[63]  A. Stephen,et al.  Starch and dietary fibre: their physiological and epidemiological interrelationships. , 1991, Canadian journal of physiology and pharmacology.

[64]  C. Gemmell,et al.  Raised titres of anti-klebsiella IgA in ankylosing spondylitis, rheumatoid arthritis, and inflammatory bowel disease , 1988, British medical journal.

[65]  O. Nielsen,et al.  CARD15 Status and Familial Predisposition for Crohn's Disease and Colonic Gene Expression , 2007, Digestive Diseases and Sciences.

[66]  M. McPherson,et al.  Collagen‐like sequences stabilize homotrimers of a bacterial hydrolase. , 1988, The EMBO journal.

[67]  Steven J Brown,et al.  The Immune Response in Inflammatory Bowel Disease , 2007, The American Journal of Gastroenterology.

[68]  G. Nuki,et al.  Systemic and mucosal antibodies to Klebsiella in patients with ankylosing spondylitis and Crohn's disease. , 1992, Annals of the rheumatic diseases.

[69]  T. W. Jeffries,et al.  Bacteria engineered for fuel ethanol production: current status , 2003, Applied Microbiology and Biotechnology.

[70]  J. Lebeault,et al.  Bacteriology and nutrition of environmental strains of Klebsiella pneumoniae involved in wood and bark decay. , 1983, Annales de microbiologie.

[71]  M. Goldacre,et al.  Inflammatory bowel disease, peptic ulcer and diverticular disease as certified causes of death in an English population 1979–2003 , 2008, European journal of gastroenterology & hepatology.

[72]  S. Meuwissen,et al.  Ankylosing spondylitis and inflammatory bowel disease. III. Clinical characteristics and results of histocompatibility typing (HLA B27) in 50 patients with both ankylosing spondylitis and inflammatory bowel disease. , 1978, Annals of the rheumatic diseases.

[73]  P Cunningham,et al.  Molecular mimicry and ankylosing spondylitis: possible role of a novel sequence in pullulanase of Klebsiella pneumoniae , 1995, FEBS letters.

[74]  R. Hammer,et al.  Correlation of Cecal Microflora of HLA-B27 Transgenic Rats with Inflammatory Bowel Disease , 1998, Infection and Immunity.

[75]  A. Akobeng,et al.  Review article: the evidence base for interventions used to maintain remission in Crohn’s disease , 2007, Alimentary pharmacology & therapeutics.

[76]  M. Vatn,et al.  Seasonal variations in the onset of ulcerative colitis. , 1996, Gut.

[77]  I. Leodolter.  [Crohn's disease]. , 1967, Wiener Zeitschrift fur innere Medizin und ihre Grenzgebiete.

[78]  B. Thjódleifsson,et al.  A common genetic background for inflammatory bowel disease and ankylosing spondylitis: a genealogic study in Iceland. , 2007, Arthritis and rheumatism.

[79]  N. Koide,et al.  Production of Murine Collagen‐Induced Arthritis Using Klebsiella pneumoniae O3 Lipopolysaccharide as a Potent Immunological Adjuvant , 1999, Microbiology and immunology.

[80]  L. Beaugerie,et al.  [Intercurrent Klebsiella oxytoca colitis in a patient with Crohn's disease]. , 2002, Gastroenterologie clinique et biologique.

[81]  S. Travis,et al.  Guidelines for the management of inflammatory bowel disease in adults , 2004, Gut.