Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract attributed to an aberrant immune response to environmental and microbial triggers. Individuals with CD exhibit an enrichment of pro-inflammatory strains of Adherent-Invasive E. coli (AIEC) and often report a relapse of symptoms following a period of acute psychological stress. Despite a known immunosuppressive role, the mechanism by which stress contributes toward the development and progression of intestinal inflammation remains unknown. Here, we use a well characterized model of restraint stress to investigate the influence of psychological stress on host protection against a CD-associated strain of AIEC. We found that stress results in profound intestinal dysbiosis, allowing for a complete dominance of Enterobacteriaceae. Interestingly, while stress alone drives a state of low-grade inflammation and loss of barrier integrity in the gut, in the presence of a pathobiont strain of AIEC, stress drives a substantially heightened inflammatory response which exacerbated the resultant loss of barrier integrity. Moreover, we have found stress induces an augmented nutritional immune response, providing AIEC a competitive niche against commensal bacteria lacking alternative methods of iron uptake. Further, we see that stress-induced glucocorticoids mediate broad apoptosis of the CD45+CD90+ lymphocytic population in the gut. The loss of this population prevents an appropriate IL-22 mediated response to dysbiosis. Accordingly, blocking glucocorticoid signalling or exogenous administration of IL-22 prevents the stress-induced expansion of AIEC. This work underscores the complex nature of psychological stress such that the combination of iron limitation and glucocorticoid mediated immune attrition are simultaneously required for the stress-induced expansion of AIEC. These findings present novel insight into the mechanistic consequences of glucocorticoid signalling on impaired immune function and the provision of an inflammatory environment, resulting in a distinct impact on CD susceptibility. As such, deeper insight regarding the complex underpinnings of CD will assist in efforts to design representative models and will strengthen the discovery of targeted therapeutics. / Thesis / Master of Science (MSc) / Crohn’s disease (CD) is an inflammatory disease of the gastrointestinal tract resulting from an exaggerated immune response. CD patients often report a relapse of symptoms following a period of psychological stress and are at an increased likelihood of having pro-inflammatory strains of E. coli within their gut. Here, we use a model of restraint stress to investigate how psychological stress modulates the abundance of bacterial species associated with CD. We found stress results in the limitation of essential nutrients, allowing for an outgrowth of E. coli. Further, stress hormones lead to the loss of a protective immune response in which E. coli expansion can be prevented by blocking these hormones or restoring immune signalling. Together, we conclude that stress leads to immune cell death and creates an iron limited environment that favours E. coli expansion. Such work begins to uncover the functional consequence of stress and its’ role in disease progression.

La maladie de Crohn (MC) est caractérisée par une inflammation intestinale chronique affectant potentiellement n'importe quel segment du tube digestif. L’étiologie de la maladie reste encore inconnue, cependant, la théorie la plus largement acceptée repose sur une réponse inflammatoire anormale dirigée contre le microbiote intestinal chez un hôte génétiquement prédisposé. Plusieurs études ont démontré que la muqueuse iléale de patients atteints de MC est anormalement colonisée par des souches de Escherichia coli adhérentes et invasives (AIEC). Toutefois, à ce jour, au Brésil, aucune étude ne démontre la présence de telles souches d’E. coli chez les patients atteints de MC. Le but de cette étude était d'isoler et de caractériser les souches de E. coli chez les patients atteints de MC au Brésil. Les biopsies ont été réalisées sur 35 sujets, 24 atteints de MC et 11 contrôles. La colonisation par des entérobactéries associées à la muqueuse iléale de patients atteints de MC a été montré élevée par rapport au groupe contrôle. Parmi les 270 souches isolées, 241 ont été identifiées comme étant des E. coli : 183 à partir de patients atteints de MC et 58 des contrôles. La recherche de différents groupes phylogénétiques de E. coli a été réalisée par PCR. Il n'y a pas de différence significative entre la répartition des groupes phylogénétiques des souches de E. coli isolées dans le groupe témoin et les patients MC. Les capacités d'adhésion et d’invasion des souches aux cellules épithéliales intestinales humaines I-407 ont été analysées, aussi bien que sa capacité à survivre et se multiplier en macrophages humains THP-1. L'analyse moléculaire par PCR a également été réalisée pour la détection des facteurs de virulence et la présence de polymorphismes génétiques associées à des souches AIEC. Dans cette étude, seuls quelques- uns des isolats de E. coli présentaient des propriétés invasives et la capacité de survivre dans les macrophages. En outre, l’analyse de la séquence fimH des souches de E. coli isolées dans cette étude n'a pas révélé la sélection de polymorphismes dans l’adhésine FimH, comme décrit pour la collection de souches AIEC isolées chez des patients européens. Ces résultats ont donc permis de montrer que les souches isolées chez les patients atteints de MC brésiliens n’ont probablement pas encore co-évolué avec leur hôte pour développer un phénotype adhérent-invasif fort, mais il sera essentiel de suivre à l'avenir l'évolution des ces souches dans la population brésilienne pour comprendre la sélection et l'évolution du phénotype AIEC. / Crohn's disease (CD) is characterized by chronic intestinal inflammation potentially affecting any segment of the digestive tract. The etiology of the disease is still unknown, however, the most widely accepted theory relies on an abnormal inflammatory response directed against the gut microbiota in a genetically predisposed host. Several studies have shown that the ileal mucosa of patients with CD is abnormally colonized by adherent and invasive Escherichia coli strains (AIEC). However, to date, in Brazil, no study has demonstrated the presence of such E. coli strains. coli in patients with CD. The purpose of this study was to isolate and characterize E. coli strains in patients with CD in Brazil. Biopsies were performed on 35 subjects, 24 with MC and 11 controls. Colonization with enterobacteria associated with the ileal mucosa of MC patients was shown to be elevated relative to the control group. Of the 270 strains isolated, 241 were identified as E. coli: 183 from CD patients and 58 controls. The search for different phylogenetic groups of E. coli was performed by PCR. There is no significant difference between the distribution of phylogenetic groups of E. coli strains isolated in the control and MC patients. The adhesion and invasion abilities of strains to human intestinal epithelial cells I-407 were analyzed, as well as its ability to survive and multiply into human macrophages THP-1. PCR molecular analysis was also performed for the detection of virulence factors and the presence of genetic polymorphisms associated with AIEC strains. In this study, only a few of the E. coli isolates had invasive properties and the ability to survive in macrophages. In addition, analysis of the fimH sequence of E. coli strains isolated in this study did not reveal the selection of polymorphisms in the FimH adhesin, as described for the collection of AIEC strains isolated from European patients. These results have thus shown that strains isolated from patients with Brazilian CD probably have not yet co-evolved with their host to develop a strong adherent-invasive phenotype, but it will be essential to monitor the future evolution of these strains in the Brazilian population to understand the selection and evolution of the AIEC phenotype.

Background: Adherent-invasive Escherichia coli (AIEC) is a pathogen isolated from the ileum of patients with CD. IFNγ is a key mediator of immunity, which regulates inflammatory responses to microbial infections. Previously, we showed enterohemorrhagic E. coli prevents STAT1 activation. Aims: To determine; 1) whether activation of STAT1 by IFNγ was prevented following AIEC infection, and 2) define the mechanisms used. Methods: Human epithelial cells were infected with AIEC strains or other pathogenic and commensal E. coli strains. Following infection, cells were stimulated with IFNγ. Activation of STAT1, was monitored by immunoblotting. Results: AIEC strains prevented STAT1 phosphorylation in response to IFNγ. Effect required live bacteria with active protein synthesis. A bacterial product was responsible for blocking STAT1 signalling and interfered with downstream signalling cascades. Conclusion: Suppression of epithelial cell STAT1 signal transduction by AIEC strains represents a novel mechanism by which the pathogen evades host immune responses to the infection.

Background: Adherent-invasive Escherichia coli (AIEC) is a pathogen isolated from the ileum of patients with CD. IFNγ is a key mediator of immunity, which regulates inflammatory responses to microbial infections. Previously, we showed enterohemorrhagic E. coli prevents STAT1 activation. Aims: To determine; 1) whether activation of STAT1 by IFNγ was prevented following AIEC infection, and 2) define the mechanisms used. Methods: Human epithelial cells were infected with AIEC strains or other pathogenic and commensal E. coli strains. Following infection, cells were stimulated with IFNγ. Activation of STAT1, was monitored by immunoblotting. Results: AIEC strains prevented STAT1 phosphorylation in response to IFNγ. Effect required live bacteria with active protein synthesis. A bacterial product was responsible for blocking STAT1 signalling and interfered with downstream signalling cascades. Conclusion: Suppression of epithelial cell STAT1 signal transduction by AIEC strains represents a novel mechanism by which the pathogen evades host immune responses to the infection.

Crohn's disease (CD) is a chronic granulomatous inflammatory bowel disease involving Mycobacterium avium subspecies paratuberculosis (MAP). Other microorganisms such as adherent-invasive Escherichia coli (AIEC) have also been proposed in CD association. To date, only one study investigated both MAP and AIEC simultaneously using peripheral blood but not in affected intestinal tissues. A standardized and effective antibiotic therapy against MAP and/or AIEC is needed for better treatment. Three antibiotic drugs – Clarithromycin (CLA), Rifabutin (RIF), and Clofazimine (CLO) have been used to treat CD patients suspected with MAP infection. However, the outcome has been controversial. The treatment dosage is high, the duration is long, and the reported drug side effects resulted in patient non-compliance; therefore, a lower and effective drug dosage is needed. In this study, we developed two aims 1) to evaluate RHB 104, a drug formula comprised of low dosages of CLA, RIF, and CLO, against clinical MAP strains in-vitro using fluorescence quenching method, and 2) to develop a fluorescence in-situ hybridization method to detect both MAP and AIEC simultaneously in intestinal tissues of CD patients. A total of 16 clinical MAP strains and 19 non-MAP strains were tested against varied concentrations of RHB 104, CLA, RIF, and CLO. Although the MIC for all drugs ranged between 0.5-20 ?g/ml, the MIC for RHB 104 was significantly lower against most MAP strains. The effect of RHB 104 against MAP was bactericidal. Unlike RHB-104 formula, CLA, CLO, and RIF dosage similar to those in RHB-104 did not inhibit MAP growth when trialed individually and in dual-drug combinations. The data illustrated the presence of synergistic anti-MAP activity of low dosage of the three antibiotics in RHB-104. We also developed a rapid and sensitive multicolor in-situ hybridization technique that can detect MAP and AIEC using tagged-oligonucleotide probes. Non-pathogenic Escherichia coli (npEC) was used as a control for the study. Specifically, cultured MAP and npEC were fixed and hybridized with MAP488 and EC647 probes, respectively. Confocal laser scanning microscope (CLSM) revealed specific signals at 488nm for MAP and 647nm for npEC, indicating probe binding to each bacteria. This was confirmed with hybridization of MAP with EC647 and npEC with MAP488 resulting in absence of signals. Intestinal tissue samples from 9 CD patients were then analyzed using our technique. Preliminary data indicated positive results in 6/6 samples for MAP, 6/6 for npEC, 3/3 for AIEC, and 2/2 for both MAP and AIEC with MAP being more dominant. This protocol shortened the FISH procedure from multiple days to short-hours. The protocol allows the investigation of more than one pathogen simultaneously in the same clinical sample. A quantitative measurement of the signals is needed.

La maladie de Crohn (MC) est une maladie inflammatoire chronique du tube digestif caractérisée par un état d’hyperactivation du système immunitaire intestinal. Les données cliniques et expérimentales montrent que l’étiologie de la MC serait une réponse immunitaire aberrante à des facteurs environnementaux et/ou infectieux chez un hôte génétiquement prédisposé. Les patients atteints de MC présentent une perméabilité intestinale anormalement élevée pouvant expliquer la stimulation du système immunitaire intestinal par les bactéries et antigènes du microbiote. La muqueuse iléale des patients atteints de MC est anormalement colonisée par des souches de Escherichia coli ayant la propriété d’adhérer et d’envahir les cellules épithéliales intestinales, de survivre et de se multiplier dans les macrophages en entraînant la sécrétion de TNF-α (Tumor Necrosis Factor-alpha). Un pathovar de E. coli associé à la MC et dénommé AIEC pour « Adherent-Invasive E. coli » a été défini. Les souches AIEC adhérent via l’adhésine FimH des pili de type 1 aux résidus mannose de la glycoprotéine CEACAM6, anormalement exprimée au niveau de l’épithélium iléal des patients atteints de MC. Au cours de la maladie, l’inflammation intestinale peut être contrôlée par les traitements médicamenteux ou la chirurgie sans pour autant obtenir de rémission complète et définitive.Le but du travail était d’analyser les conséquences de l’infection par des bactéries AIEC in vivo dans un modèle murin reproduisant l’interaction AIEC/CEACAM6 et de proposer des stratégies pour éliminer ces bactéries de l’intestin. Nous avons montré que les AIEC avaient la capacité d’altérer la fonction de barrière de l’épithélium intestinal chez des souris transgéniques CEABAC10 exprimant CEACAM6. Cette altération est associée à une forte induction de l’expression de la protéine de jonction Claudine-2, comme observée chez les patients atteints de MC. Nous avons ensuite démontré que la levure S. cerevisiae CNCM I-3856 et des produits de levures étaient capables de maintenir l’intégrité de la barrière intestinale des souris en prévenant la colonisation du tractus digestif par les bactéries AIEC. Dans une deuxième partie, nous nous sommes intéressés au développement de nouvelles molécules antagonistes de l’adhésine FimH. Les thiazolylaminomannosides ont montré un puissant effet inhibiteur de l’adhésion des bactéries AIEC à des cellules épithéliales intestinales. Les heptyl-mannosides sont également de puissants inhibiteurs de l’adhésion des AIEC et leur présentation en multivalence sur des corps polymériques ou des cyclodextrines potentialisent l’effet anti-adhésif. De manière intéressante, certains heptyl-mannosides diminuent fortement la colonisation de l’intestin par les bactéries AIEC et préviennent la colite chez des souris CEABAC10. Toutefois, la multivalence n’apporte pas d’efficacité supplémentaire dans ce contexte. En conclusion, deux stratégies anti-adhésives ont été étudiées : les levures et les mannosides. Elles pourraient être proposées aux patients atteints de MC fortement colonisés par les AIEC afin d’éliminer ces bactéries du tractus digestif pour espérer diminuer l’inflammation. Les perspectives à ce travail seront la mise au point de techniques de détection simples et rapides des personnes colonisées ou susceptibles d’être colonisées par ces souches de E. coli pour cibler la population à traiter par les probiotiques levures et les molécules anti-adhésives. / Crohn’s disease (CD) is an inflammatory bowel disease (IBD) with a multifactorial etiology, resulting from an exacerbated inflammatory response to intestinal microbes and/or microbial components in genetically susceptible hosts. CD patients present an increased intestinal permeability which can favor the overstimulation of the intestinal immune system by bacteria or antigens from microbiota. Ileal mucosa from CD patients is abnormally colonized by Escherichia coli strains sharing the ability to adhere to and to invade intestinal epithelial cells, to survive and to replicate within macrophages, inducing high secretion of TNF-α (Tumor Necrosis Factor-). These strains associated with CD are grouped in a pathovar of E. coli named AIEC for « Adherent-Invasive E. coli ». AIEC bacteria adhere via the adhesin FimH localized at the tip of the type 1 pili, to mannose residues exposed on the glycoprotein CEACAM6 abnormally expressed at the ileal mucosa of CD patients. Currently, intestinal inflammation can be controlled with drugs or intestinal surgery but total remission cannot be yet achieved. The aim of the present work was to investigate consequences of AIEC infection in a murine model mimicking the AIEC/CEACAM6 interaction and to test different strategies to eradicate these bacteria from the gut. We showed that AIEC bacteria altered barrier function of the intestinal epithelium in transgenic CEABAC10 mice expressing human CEACAM6. The overexpression of the pore-forming tight junction protein claudin-2 was correlated with the increase intestinal permeability, as observed in CD patients. We demonstrated that the yeast strain S. cerevisiae CNCM I-3856, as well as some yeast products, were able to prevent increase of intestinal permeability in decreasing AIEC gut colonization. In a second part, we investigated another strategy targeting AIEC bacteria using antagonists to FimH adhesin. Thiazolylaminomannosides molecules exerted a strong inhibitory effect on the ability of AIEC bacteria to adhere to intestinal epithelial cells. Heptyl-mannosides (HM) also shared high inhibitory properties in vitro and their efficacy can be potentiated when HM are harbored in multiple copies on polymeric or cyclodextrin cores. Interestingly, some HM molecules strongly decreased AIEC gut colonization and the signs of colitis in vivo, in AIEC LF82-infected CEABAC10 mice. In that context, multivalency did not improve inhibitors efficacy.To conclude, two different strategies were studied: probiotic yeasts and anti-adhesive mannosides. These treatments should be proposed in CD patients highly colonized by AIEC bacteria in order to eliminate these bacteria from the gut and to decrease intestinal inflammation. Future works will focus on the development of quick and easy detection methods to determine people colonized or susceptible to be colonized by AIEC bacteria to treat this subpopulation of CD patients.