What role do bacteria play in persisting fistula formation in idiopathic and Crohn's anal fistula?

Tozer, Phil; Rayment, Neil B.; Hart, Ailsa; Daulatzai, N; Murugananthan, Aravinth; Whelan, Kevin; Phillips, R. K. S.

doi:10.1111/codi.12810

Cited by 52 publications

(38 citation statements)

References 19 publications

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“…It is therefore of relevance to point out microbiological differences that may occur between the two diseases. A recent study investigated the potential presence of bacteria in Crohn's and idiopathic anal fistulas using FISH and scanning electron microscopy ( n = 51) . Interestingly, the study indicated that Crohn's fistulas do not harbour specific bacteria, which is in contrast to our findings.…”

Section: Discussioncontrasting

confidence: 99%

The microbiome of tunnels in hidradenitis suppurativa patients

Ring

Sigsgaard

Thorsen

et al. 2019

Acad Dermatol Venereol

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Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous regions. Recent next‐generation sequencing (NGS) studies suggest genera such as Prevotella spp., Peptoniphilus spp. and Porphyromonas spp. are associated with chronic and early HS lesions. However, a systematic investigation of the bacterial microbiome in HS tunnels remains unexplored using NGS. Objective We aimed to investigate the bacterial composition of the luminal white gelatinous material found in HS tunnels using NGS. Methods An exploratory study of patients with diagnosis of HS (n = 32) with tunnels. The tunnels were present either in the groin (n = 17) or in the axilla (n = 15). During deroofing of the tunnels, a sterile E‐swab was taken of the luminal gelatinous material. The samples were investigated using NGS targeting 16S ribosomal RNA. Results The skin microbiome was characterized in 32 HS patients. Overall, five microbiome types were identified: Porphyromonas spp. (type I), Corynebacterium spp., (type II), Staphylococcus spp. (type III), Prevotella spp. (type IV) and Acinetobacter spp (type V). Porphyromonas spp. (type I) and Prevotella spp. (IV) were the most frequent genera found the tunnels. Conclusion This study points to a potential association between the presence of certain anaerobic bacteria (Porphyromonas spp., Prevotella spp.) and HS tunnels. It may be speculated that these two genera are associated with the pathogenesis in HS either as drivers or as biomarkers.

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Section: Discussioncontrasting

confidence: 99%

The microbiome of tunnels in hidradenitis suppurativa patients

Ring

Sigsgaard

Thorsen

et al. 2019

Acad Dermatol Venereol

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“…Therefore, it seems unlikely that bacterial infection plays a major role in persistence of fistula after surgery. These results were recently confirmed by Tozer et al [4]. …”

Section: Introductionsupporting

confidence: 81%

Pro-inflammatory cytokines in cryptoglandular anal fistulas

et al. 2016

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BackgroundSphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α).MethodsFistula tract tissue was obtained from 27 patients with a transsphincteric fistula of cryptoglandular origin who underwent flap repair, ligation of the intersphincteric fistula tract or a combination of both procedures. Patients with a rectovaginal fistula or a fistula due to Crohn’s disease were excluded. Frozen tissue samples were sectioned and stained using advanced immuno-enzyme staining methods for detection of selected cytokines, IL-1β, IL-8, IL-10, IL-12p40, IL-17A, IL-18, IL-36 and TNF-α. The presence and frequencies of cytokine-producing cells in samples were quantitated.ResultsThe key finding was abundant expression of IL-1β in 93 % of the anal fistulas. Frequencies of IL-1β-producing cells were highest (>50 positive stained cells) in 7 % of the anal fistulas. Also, cytokines IL-8, IL-12p40 and TNF-α were present in respectively 70, 33 and 30 % of the anal fistulas.ConclusionsIL-1β is expressed in the large majority of cryptoglandular anal fistulas, as well as several other pro-inflammatory cytokines.

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“…Two groups have tried to address these issues and to understand the microbiota within the perianal fistula track. In one study, 32 fistula tracks (14 Crohn's, 18 idiopathic) were sampled using fluorescent in situ hybridisation which allows identification and quantification of mucosa‐associated bacteria held within the mucus layer of the luminal surface of the fistula track . No luminal bacteria were found despite the additional use of several techniques (including “no wash” collection techniques and scanning electron microscopy (SEM)) to ensure technical causes were not responsible for the paucity of bacteria seen.…”

Section: Methodsmentioning

confidence: 99%