Therapeutic Potential of Escherichia coli Nissle 1917 in Clinically Remission-attained Ulcerative Colitis Patients: A Hospital-based Cohort Study

Abstract

Background/Aims: Escherichia coli Nissle 1917 (EcN) alone therapy is as effective as mesalamine in inducing and maintaining remission in ulcerative colitis (UC). The efficacy and safety of EcN in combination with standard therapies have not been studied. This study examined the changes in the inflammation markers and symptoms following the additional administration of EcN to patients showing the clinical remission of UC. Methods: UC patients who received EcN after being in clinical remission for more than 3 months at Kosin University Gospel Hospital between 2013 and 2018 were evaluated through the retrospective medical-record-based review. The partial Mayo score, fecal calprotectin (FC), BMI, hemoglobin, serum cholesterol, serum albumin levels, and the safety profiles were examined at 3rd and 6th months after initiating EcN. Results: Ninety-four patients were included. After 3 months of treatment, there was no significant change in FC (156.3 μg/g to 141.1 μg/g) (p=0.653). On the other hand, partial Mayo score decreased significantly from 0.085 to 0.014 (p=0.025), and the bodyweight (p=0.001), BMI (p<0.001), hemoglobin (p=0.009), and cholesterol level increased (p=0.148). One patient (1.1%) experienced a serious adverse event with UC flare-up, and 14 patients (14.9%) discontinued EcN due to adverse events; all developed within 3 months. Conclusions: Additional administration of EcN to clinically remission-attained UC patients may improve the UC symptoms without changing the FC levels. EcN-associated adverse events develop within the early few weeks.

Role of adherent invasive Escherichia coli in pathogenesis of inflammatory bowel disease

“…AIEC is considered to be a pathobiont, although many AIEC strain genomes encode virulence genes, and pathogenicity of the prototype strain LF82 has been reported[ 104 ]. This pathophysiology is supported by clinical data showing that IBD patients have underlying genetic mutations and that inflammation may be caused by a distinct microbiome not an infectious pathogen.…”

Characterization of the Inflammatory Response Evoked by Bacterial Membrane Vesicles in Intestinal Cells Reveals an RIPK2-Dependent Activation by Enterotoxigenic Escherichia coli Vesicles

“…Notably, OMVs from the probiotic strain E. coli Nissle demonstrated relatively high proinflammatory potency in our cell culture assays. Although suggested as alternative therapy to maintain remission in ulcerative colitis patients with comparable efficacy to the established gold standard therapy based on mesalazine, a recent study indicates adverse effects in 15% of the patients receiving E. coli Nissle within the first few weeks ( 61 , 62 ). Concordantly, severe adverse effects by E. coli Nissle were reported in a mouse model with disturbed microbiota and impaired adaptive immunity ( 63 ).…”

Therapeutic Effects of Zymomonas mobilis on Experimental DSS-Induced Colitis Mouse Model

“…Even though no specific treatment is available, the use of probiotics could lead to benefits in terms of disease control. For example, E. coli Nissle 1917 (Mutaflor, Ardeypharm) has been shown to induce remission of UC in patients and maintain it for a certain period [30,31]. This effect was also compared with the drug aminosalicylate mesalamine, one of the main treatments for UC [32][33][34].…”