Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Enterotoxigenic Bacteroides fragilis-Associated Diseases and Detection

Enterotoxigenic Bacteroides fragilis에 의한 질환과 검출

  • Gwon, Sun-Yeong (Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University at Wonju) ;
  • Jang, In-Ho (Department of Biomedical Laboratory Science, College of Health Sciences, Sangji University) ;
  • Rhee, Ki-Jong (Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University at Wonju)
  • 권선영 (연세대학교 보건과학대학 임상병리학과) ;
  • 장인호 (상지대학교 보건과학대학 임상병리학과) ;
  • 이기종 (연세대학교 보건과학대학 임상병리학과)
  • Received : 2015.11.12
  • Accepted : 2015.11.21
  • Published : 2015.12.30
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Abstract

These commensal intestinal bacteria can enhance the immune system and aid in nutrient absorption but can also act as opportunistic pathogens. Among these intestinal bacteria, the anaerobic Bacteroides fragilis are divided into enterotoxigenic B. fragilis (ETBF) which secrete the B. fragilis toxin (BFT) and non-enterotoxigenic B. fragilis (NTBF) which do not secrete BFT. ETBF can cause diarrhea and colitis in both humans and livestock but can also be found in asymptomatic individuals. ETBF is predominantly found in patients with inflammatory diarrheal diseases and traveller's diarrhea. Several clinical studies have also reported an increased prevalence of ETBF in human patients with inflammatory bowel disease (IBD), colitis and colorectal cancer. In small animal models (C57BL/6 wild-type mice, germ-free mice, multiple intestinal neoplasia (Min) mice, rabbits and Mongolian gerbils), ETBF have been found to initiate and/or aggravate IBD, colitis and colorectal cancer. BFT induces E-cadherin cleavage in intestinal epithelial cells resulting in loss of epithelial cell integrity. Subsequent activation of the ${\beta}$-catenin pathway leads to increased cellular proliferation. In addition, ETBF causes acute and chronic colitis in wild-type mice as well as enhances tumorigenesis in Min mice via activation of the Stat3/Th17 pathway. Currently, ETBF can be detected using a BFT toxin bioassay and by PCR. Advances in molecular biological techniques such as real-time PCR have allowed both researchers as well as clinicians to rapidly detect ETBF in clinical samples. The emergence of more sensitive techniques will likely advance molecular insight into the role of ETBF in colitis and cancer.

정상인에서 장내세균은 숙주의 면역이나 영양 흡수를 돕지만, 때로는 기회감염균으로서 그들을 위협하기도 한다. 그 중 절대 혐기성 세균인 Bacteroides fragilis는 분비되는 장독소(enterotoxin)인 Bacteroides fragilis toxin (BFT)의 유무에 따라 non-enterotoxigenic B. fragilis (NTBF)와 enterotoxigenic B. fragilis (ETBF)로 나뉜다. ETBF는 가축 및 사람에서 설사 질환 및 대장 질환을 유발한다 그러나 때때로 ETBF를 가지고 있으나 증상이 없는 사람도 존재한다. ETBF는 염증성 설사 질환, 여행자 설사 환자의 대변에서 검출되어 주목 받고 있다. 또한, 몇몇 연구를 통해 inflammatory bowel disease (IBD)나 대장염 및 대장암 환자에서 ETBF가 증가한다는 것이 밝혀졌다. 일반 C57BL/6 마우스 및 germ-free 마우스, multiple intestinal neoplasia (Min) 마우스, 토끼, Mongolian gerbil 등 여러 동물 모델에서 ETBF가 IBD나 대장염, 대장암을 유발 또는 촉진한다는 것이 발표되었다. ETBF의 유일한 병원성 인자인 BFT는 E-cadherin의 분절을 유도하여 장상피 세포의 투과성을 높인다. 이어서 ${\beta}$-catenin 신호전달계가 활성화하여 장상피세포의 증식이 증가한다. 또한 ETBF의 감염은 일반 마우스에서 급성이나 만성의 대장염을 일으키고 Min 마우스에서 종양 형성을 촉진한다. 이는 Stat3에 의존한 $T_H17$ 면역반응의 활성화를 통해 일어난다. 현재 ETBF의 검출 방법에는 크게 BFT toxin assay와 몇 가지 PCR 방법이 있다. 최근 real-time PCR과 같은 분자진단학적 기법의 발달로 일반적인 PCR보다 더 정확한 ETBF의 검출이 가능하게 되었다. 이것을 이용하여 앞으로 실제 임상에서 ETBF와 대장염 및 대장암의 발달 관계에 대한 심도 깊은 연구가 이뤄질 것으로 본다.

Keywords

References

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