Enhanced jejunal production of antibodies to Klebsiella and other Enterobacteria in patients with ankylosing spondylitis and rheumatoid arthritis

Abstract

Objective-To measure gut immunity directly in jejunal fluid in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Methods-Antibodies against three diVerent Enterobacterias were measured in jejunal perfusion fluids (collected by a double balloon perfusion device) of 19 patients with AS, 14 patients with RA, and 22 healthy controls using enzyme linked immunosorbent assay. Results-The AS patients had significantly increased jejunal fluid concentrations of IgM, IgG, and IgA class antibodies against Klebsiella pneumoniae, and IgM and IgA class antibodies against Escherichia coli and Proteus mirabilis compared with healthy controls. When compared with the patients with RA, the AS patients had higher concentrations of IgA and IgG class antibodies only against K pneumoniae. The RA patients had higher IgM class antibody concentrations against all three studied Enterobacterias, when compared with the healthy controls, suggesting an enhanced mucosal immune response in these patients. A three month treatment with sulphasalazine did not decrease enterobacterial antibody concentrations in the 10 patients with AS. Conclusion-There is strong direct evidence for an abnormal mucosal humoral immune response particularly to K pneumoniae in patients with AS.

Ankylosing Spondylitis, HLA-B27 and Klebsiella - An Overview: Proposal for Early Diagnosis and Treatment

“…(11) AS patients were found to have an increased jejunal production of Klebsiella antibodies when compared to rheumatoid arthritis patients or controls [71].…”

Insights into the role of infection in the spondyloarthropathies

“…Cellular hyporeactivity of peripheral blood cells to bacterial antigens may reflect defective T-cell responses, allowing bacterial antigens to persist in diseased patients. The predominating IgA antibody responses imply that mucosa, probably the gut mucosa, is important in eliciting these responses [21,22]. Mucosal inflammation has been demonstrated in a large percentage of patients with AS, as in patients with SpA [23••], suggesting that the initial immune responses occur in gut mucosa.…”

The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis

“…11 However, we found that intestinal fluid from RA patients contained only low levels of IgA and IgM RF, some 1000 times less than in serum. 15 The IgA, but notably not the IgM, RF activities were generally well correlated with the food antibody levels of all the three Ig classes (r = 0.65 to 0.94; p = 0.01 to 0.0001).…”

“…Most of the subjects were included in a previously reported study of microbial antibodies. 15 Jejunal perfusion fluid A segment of the jejunum was perfused, as detailed elsewhere, by a small diameter tube 175 cm long and containing six channels. 16 The original report described the insertion of the tube, gastric drainage, inflation of the balloons, and rinsing of the closed intestinal segment.…”