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World J Gastroenterol. Jun 28, 2016; 22(24): 5505-5511
Published online Jun 28, 2016. doi: 10.3748/wjg.v22.i24.5505
Role and mechanisms of action of Escherichia coli Nissle 1917 in the maintenance of remission in ulcerative colitis patients: An update
Franco Scaldaferri, Viviana Gerardi, Francesca Mangiola, Loris Riccardo Lopetuso, Marco Pizzoferrato, Valentina Petito, Alfredo Papa, Jovana Stojanovic, Andrea Poscia, Giovanni Cammarota, Antonio Gasbarrini
Franco Scaldaferri, Viviana Gerardi, Francesca Mangiola, Loris Riccardo Lopetuso, Marco Pizzoferrato, Valentina Petito, Alfredo Papa, Giovanni Cammarota, Antonio Gasbarrini, Polo Apparato digerente e sistema Endocrino Metabolico, Gastroenterology Division, Catholic University of Sacred Hearth, 00168 Rome, Italy
Jovana Stojanovic, Andrea Poscia, Institute of Hygiene, Catholic University of Sacred Hearth, 00168 Rome, Italy
Author contributions: Scaldaferri F and Gerardi V equally contributed; Scaldaferri F, Gerardi V and Gasbarrini A contributed to study design; Scaldaferri F, Gerardi V, Mangiola F, Lopetuso LR, Pizzoferrato M, Petito V, Stojanovic J and Poscia A made literature search; Scaldaferri F and Gerardi V made figures and wrote the paper; Stojanovic J and Poscia A performed the metanalysis; all authors contributed to data interpretation, editing.
Conflict-of-interest statement: Scaldaferri F and Gasbarrini A were consultants for Ca.Digroup; however, each author has no financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Franco Scaldaferri, MD, PhD, Centre for the Research and Cure of Inflammatory Bowel Disease, UOC di Medicina Interna e Gastroenterologia, Institute of Medical Pathology, Catholic University of the Sacred Hearth, Fondazione Policlinico “A. Gemelli” Hospital, lgo Gemelli 8, 00168 Roma, Italy. francoscaldaferri@gmail.com
Telephone: +39-6-30155923 Fax: +39-6-30157249
Received: January 11, 2016
Peer-review started: January 13, 2016
First decision: February 18, 2016
Revised: March 12, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 28, 2016
Processing time: 162 Days and 12.3 Hours
Abstract

Ulcerative colitis (UC) is a chronic inflammatory disease, whose etiology is still unclear. Its pathogenesis involves an interaction between genetic factors, immune response and the “forgotten organ”, Gut Microbiota. Several studies have been conducted to assess the role of antibiotics and probiotics as additional or alternative therapies for Ulcerative Colitis. Escherichia coli Nissle (EcN) is a nonpathogenic Gram-negative strain isolated in 1917 by Alfred Nissle and it is the active component of microbial drug Mutaflor® (Ardeypharm GmbH, Herdecke, Germany and EcN, Cadigroup, In Italy) used in many gastrointestinal disorder including diarrhea, uncomplicated diverticular disease and UC. It is the only probiotic recommended in ECCO guidelines as effective alternative to mesalazine in maintenance of remission in UC patients. In this review we propose an update on the role of EcN 1917 in maintenance of remission in UC patients, including data about efficacy and safety. Further studies may be helpful for this subject to further the full use of potential of EcN.

Keywords: Ulcerative colitis, Escherichia coli Nissle, Metanalysis, Probiotic, Randomized trial, Inflammatory bowel disease

Core tip:Escherichia coli (E. coli) Nissle is a nonpathogenic Gram-negative strain used as a probiotic with very good quality paper assessing its bio-equivalence to mesalazine in maintaining remission in ulcerative colitis. Mechanisms of actions of this compound include immune-modulatory properties, reinforcement of intestinal barrier and inhibitory effect towards other pathogenic E. coli.