Role and mechanisms of action of Escherichia coli Nissle 1917 in the maintenance of remission in ulcerative colitis patients Original paper

What was studied?

This review focuses on the role and mechanisms of Escherichia coli Nissle 1917 (EcN) in maintaining remission in patients with ulcerative colitis (UC). The study examines how EcN, a non-pathogenic, Gram-negative bacterium, influences the gut microbiota to achieve beneficial effects in the management of UC. It examines its probiotic properties, including immune modulation, antimicrobial effects, and reinforcement of intestinal barrier function. The paper also presents clinical trial data comparing EcN with conventional therapies such as mesalazine for preventing UC relapses. EcN’s effectiveness, safety, and mechanisms of action are further discussed, along with insights into its potential as an adjunctive therapy in UC treatment.

Who was studied?

The review primarily focuses on Escherichia coli Nissle 1917 (EcN) and its use in clinical settings for managing ulcerative colitis (UC). It draws upon multiple clinical trials involving UC patients, comparing EcN with standard therapies like mesalazine (5-aminosalicylic acid) for relapse prevention. Studies involving both adult and pediatric UC populations are discussed, with emphasis on the effectiveness of EcN in maintaining remission after an acute flare of UC. It also includes animal models that assess the probiotic’s effects on intestinal inflammation and microbial composition.

Most important findings

The review found that Escherichia coli Nissle 1917 (EcN) is effective in maintaining remission in UC patients, with clinical trials demonstrating its efficacy comparable to that of mesalazine in preventing disease relapse. In one major study, EcN demonstrated similar relapse rates to mesalazine, with no significant differences in clinical activity index (CAI), endoscopic evaluation, or histological measures. EcN also provided anti-inflammatory benefits by reducing pro-inflammatory cytokines and enhancing mucosal integrity. The probiotic strain’s mechanisms of action include immune modulation via toll-like receptors, production of antimicrobial substances (e.g., microcins), and promotion of tight junctions between intestinal epithelial cells. These effects help to stabilize the gut microbiota, reduce inflammation, and enhance the gut barrier function. Moreover, EcN’s safety profile was robust, with minimal adverse effects reported in clinical trials.

Key implications

EcN offers a safe, effective, and well-tolerated alternative to traditional therapies like mesalazine in managing ulcerative colitis. Its ability to modulate the immune system, strengthen the intestinal barrier, and reduce inflammation positions it as a promising adjunct or alternative therapy in UC management. The findings highlight the growing role of probiotics in chronic disease management, particularly in conditions like UC where the microbiota plays a crucial role. Further studies are needed to optimize the use of EcN, determine the most effective dosing strategies, and explore its long-term benefits for UC patients.