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J. Exp. Med. Vol. 206 No. 10 2179-2189
Inflammatory bowel disease (IBD) mainly con-
sists of two disorders, ulcerative colitis and
Crohn’s disease (CD), with a combined preva-
lence of 150–200 cases per 100,000 in West-
ern countries (Shanahan, 2002; Loftus, 2004).
The abnormal inflammatory response observed
in IBD requires interplay between host genetic
factors and the intestinal microbiota (Podolsky,
2002; for review see Strober et al., 2007). The
role of the microbiota in IBD development is
highlighted with the following observations: in
CD patients, postsurgical exposure of the ter-
minal ileum to luminal contents is associated
with increased inflammation, and diversion of
the fecal stream is associated with improvement
(Rutgeerts et al., 1991); some IBD patients im-
prove upon antibiotic treatment (Sartor, 2004;
Sands, 2007); the severity of colitis in multiple
animal models is decreased by the administra-
tion of antibiotics; and no sign of colitis is ob-
served when those animals are in germ-free
conditions (for review see Sartor, 2008).
Two broad hypotheses have arisen regard-
ing the role of the intestinal microbiota in the
pathogenesis of IBD. Several lines of evidence
support the notion that IBD results from an ex-
cessive immune response to gut commensal
organisms (for review see Strober et al., 2007).
Abbreviations used: AIEC,
adherent-invasive E. coli; CD,
Crohn’s disease; CEACAM,
related cell adhesion molecule;
CMC, carboxymethyl cellulose;
DAI, disease activity index; GI,
gastrointestinal; IBD, inflamma-
tory bowel disease.
F.A. Carvalho and N. Barnich contributed equally to this
Crohn’s disease adherent-invasive Escherichia
coli colonize and induce strong gut
inflammation in transgenic mice expressing
Frédéric A. Carvalho,1 Nicolas Barnich,1,2 Adeline Sivignon,1,2
Claude Darcha,3 Carlos H.F. Chan,4 Clifford P. Stanners,5
and Arlette Darfeuille-Michaud1,2
1Université Clermont 1, Pathogénie Bactérienne Intestinale, JE2526, Unité Sous Contrat Institut National de la Recherche
Agronomique 2018, Clermont-Ferrand F-63001, France
2Institut Universitaire de Technologie en Génie Biologique, Aubière F-63172, France
3Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire, Clermont-Ferrand F-63001, France
4Department of Surgery and 5Department of Biochemistry and McGill Cancer Centre, McGill University, Montréal,
Abnormal expression of CEACAM6 is observed at the apical surface of the ileal epithelium
in Crohn’s disease (CD) patients, and CD ileal lesions are colonized by pathogenic adherent-
invasive Escherichia coli (AIEC). We investigated the ability of AIEC reference strain LF82
to colonize the intestinal mucosa and to induce inflammation in CEABAC10 transgenic mice
expressing human CEACAMs. AIEC LF82 virulent bacteria, but not nonpathogenic E. coli
K-12, were able to persist in the gut of CEABAC10 transgenic mice and to induce severe
colitis with reduced survival rate, marked weight loss, increased rectal bleeding, presence of
erosive lesions, mucosal inflammation, and increased proinflammatory cytokine expression.
The colitis depended on type 1 pili expression by AIEC bacteria and on intestinal CEACAM
expression because no sign of colitis was observed in transgenic mice infected with type 1
pili–negative LF82-fimH isogenic mutant or in wild-type mice infected with AIEC LF82
bacteria. These findings strongly support the hypothesis that in CD patients having an
abnormal intestinal expression of CEACAM6, AIEC bacteria via type 1 pili expression can
colonize the intestinal mucosa and induce gut inflammation. Thus, targeting AIEC adhesion
to gut mucosa represents a new strategy for clinicians to prevent and/or to treat ileal CD.
© 2009 Carvalho et al. This article is distributed under the terms of an Attribu-
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The Journal of Experimental Medicine
CEACAM INTESTINAL EXPRESSION AND AIEC COLONIZATION | Carvalho et al.
numbers of mucosa-associated Escherichia coli are observed
(Darfeuille-Michaud et al., 1998; Martin et al., 2004; Conte
et al., 2006; Baumgart et al., 2007; Kotlowski et al., 2007;
Sasaki et al., 2007). This overgrowth of E. coli can result from
host-mediated inflammation or abnormal expression of mol-
ecules acting as receptors for bacterial adhesion. In CD pa-
tients with ileal involvement of the disease, we recently
reported an abnormal ileal expression of carcinoembryonic
antigen-related cell adhesion molecules (CEACAMs) 5 and 6
(Barnich et al., 2007) and showed that only CEACAM6 acts
as a receptor for pathogenic E. coli. These bacteria, called ad-
herent-invasive E. coli (AIEC), colonize the ileal mucosa of
CD patients (Darfeuille-Michaud et al., 2004). They are able
to adhere to and invade intestinal epithelial cells and to sur-
vive and highly replicate within macrophages, leading to the
secretion of high amounts of TNF (Boudeau et al., 1999;
Glasser et al., 2001). Interestingly, in vitro studies demon-
strated that CEACAM6 expression is increased in cultured
However, the disease could result from a problem in the
composition of the microflora leading to generalized or local-
ized dysbiosis. Thus, a breakdown in the balance between
putative species of “protective” versus “harmful” intestinal
bacteria has been reported and may promote inflammation.
A low proportion of Faecalibacterium prausnitzii on resected ileal
Crohn mucosa is associated with endoscopic recurrence at
6 mo, and this bacteria has antiinflammatory properties
(Tamboli et al., 2004; Sokol et al., 2008). In addition, host-
mediated inflammation in response to a pathogen infection
can disrupt the intestinal microbiota and shift the balance be-
tween the protective microbiota and the pathogen in favor of
the pathogen, as seen with Citrobacter rodentium infection pro-
moting the overgrowth of Enterobacteriaceae (Lupp et al.,
2007) and with Salmonella Typhimurium infection (Stecher
et al., 2007). In patients with CD and ulcerative colitis, high
concentrations of bacteria forming a biofilm on the surface
of the gut mucosa (Swidsinski et al., 2002) and increased
Figure 1. AIEC LF82 bacterial colonization and persistence in mouse intestine according to CEACAM expression. (A and B) Quantification of
AIEC LF82 (A) or E. coli K-12 MG1655 (B) in the feces of WT (wt, white triangles) or CEABAC10 (tg, black triangles) mice receiving 0.25% DSS in drinking
water after oral infection with 109 bacteria at day 0. (C) Quantification of colonic mucosal-associated AIEC LF82 bacteria at day 7 after oral infection. The
quantification for each mouse (symbols) and the median (bars) is expressed as CFU/g of feces or CFU/mg of organ tissue. (D) Confocal microscopy analy-
sis of colonic section at day 7 after infection from WT or transgenic mice infected with AIEC LF82. CEACAM6 expression was detected using anti-
CEACAM6 monoclonal antibody and a Cy3-conjugated anti–mouse IgG. AIEC LF82 bacteria were detected using anti-O83 rabbit antibody and a
FITC-conjugated anti–rabbit IgG. Arrow shows colocalization (yellow staining) between CEACAM6 and bacteria. WT FVB/N mice: E. coli K-12 MG1655 in-
fected (n = 13), AIEC LF82 infected (n = 9); CEABAC10 transgenic FVB/N mice: E. coli K-12-MG1655 (n = 13), AIEC LF82-infected (n = 15). Results shown
here are representative of three separate colonization experiments. *, P < 0.05; ***, P < 0.001. Bars, 50 µm.
JEM VOL. 206, September 28, 2009
significantly (P = 0.013) more AIEC LF82 bacteria were
found in stools of mice expressing human CEACAMs (3.0 ×
108 CFU/g of feces) compared with WT mice (8.5 × 107
CFU/g of feces; Fig. 1 A). At day 6, the differences between
WT and transgenic mice were even higher and statistically
more significant (P = 0.002) because the median number of
AIEC LF82 bacteria found in stools of transgenic mice was
1.1 × 106 CFU/g of feces compared with 1.3 × 104 CFU/g
of feces for WT mice (Fig. 1 A). It is of note that at day 6 after
infection, 10/10 of the CEABAC10 mice still presented more
than 105 CFU of AIEC LF82 per gram of feces compared
with only 3/13 for WT mice. When experiments were per-
formed with the nonpathogenic E. coli K-12, no differences in
the numbers of bacteria in the stools were encountered be-
tween WT and transgenic mice (Fig. 1 B). Bacteria counts
rapidly decreased in the feces of WT or transgenic mice be-
cause only 3.1 × 106 CFU/g of feces and 2.1 × 106 CFU/g of
feces, respectively, were found at day 1 after infection. At day
3 after infection, the number of E. coli K-12 bacteria present
in feces of infected mice was <105 CFU/g of feces.
To confirm AIEC LF82 colonization, we determined the
number of colonic mucosa-associated bacteria to investigate
whether the presence of AIEC LF82 bacteria in the feces
intestinal epithelial cells not only after IFN- or TNF stimu-
lation (Fahlgren et al., 2003) but also after infection with
AIEC bacteria, indicating that AIEC could promote their
own colonization in CD patients (Barnich et al., 2007). In
the present paper, using transgenic CEABAC10 mice har-
boring a bacterial artificial chromosome that contains part of
the human CEA family gene cluster, including complete
human CEACAM3, CEACAM5 (CEA), CEACAM6, and
CEACAM7 genes (Chan and Stanners, 2004), we investi-
gated whether LF82 bacteria isolated from a CD patient can
colonize the intestinal mucosa as a result of CEACAM ex-
pression and whether AIEC LF82 colonization could lead to
the development of gut inflammation.
Intestinal expression of human CEACAMs allowed AIEC
LF82 gastrointestinal (GI) colonization and persistence
WT FVB/N and CEABAC10 mice were orally challenged
with 109 bacteria, and the level of bacteria in the stools was
followed to evaluate bacterial colonization rate. The analysis
of the presence of AIEC bacteria in the stools revealed that
there were no differences in bacterial counts between WT
mice and transgenic mice until day 2 after infection. At day 3,
Figure 2. AIEC LF82 bacteria induced clinical symptoms of colitis in CEABAC10 transgenic mice. (A–F) AIEC LF82 infections were performed in
WT (A–C) and in CEABAC10 (D–F) mice. Shown is evolution of body weight (A and D), survival rate (B and E), and DAI score ascertained at day 7 after in-
fection (C and F) of mice orally challenged at day 0 with CMC alone (black circles), with CMC containing 109 E. coli K-12 MG1655 bacteria (white trian-
gles), or with CMC containing 109 AIEC LF82 bacteria (white squares). (G) Quantification of AIEC LF82 at day 7 after infection in the liver and spleen. WT
FVB/N mice: CMC alone (n = 11), E. coli K-12 MG1655 infected (n = 7), AIEC LF82 infected (n = 14); CEABAC10 transgenic FVB/N mice: CMC alone (n = 9),
E. coli K-12 MG1655 infected (n = 11), AIEC LF82 infected (n = 15). Shown here are representative body weight evolution, survival rate, and DAI of three
separate experiments. Horizontal bars represent medians. Error bars represent SEM. **, P < 0.01; ***, P < 0.001 (compared with noninfected mice).
CEACAM INTESTINAL EXPRESSION AND AIEC COLONIZATION | Carvalho et al.
DAI score of transgenic mice infected with AIEC LF82 bac-
teria was significantly higher at day 6 (5.4 ± 0.3) compared
with noninfected mice (0.8 ± 0.5; P < 0.001) or those in-
fected with E. coli K-12 (0.3 ± 0.3; P < 0.001; Fig. 2 F).
AIEC colonization in WT mice over a 14-d period did not
decrease body weight or result in mortality. Similar results
were observed in CEABAC10 mice administered with K-12
bacteria (unpublished data). In addition, dissemination of
AIEC LF82 bacteria was observed in the liver and the spleen
of three and four transgenic mice, respectively (Fig. 2 G), but
in no infected WT mice.
To confirm the involvement of human CEACAM6 in
AIEC LF82 colonization and induction of inflammation in
transgenic mice, AIEC-infected transgenic mice received in-
traperitoneal injections of anti-CEACAM6 monoclonal anti-
body 9A6 1 d before infection and at days 0, 1, and 3 after
infection. The resulting blockade of CEACAM6 receptor
significantly decreased AIEC LF82 colonization until the
mice received anti-CEACAM6 monoclonal antibodies
(Fig. 3 A). Significantly lower DAI scores and significant
gains in body weight were also observed at day 6 after infec-
tion (Fig. 3, B and C). Overall, these results therefore indi-
cate that among the various human CEACAMs expressed by
transgenic mice, CEACAM6 is required to allow CD-associ-
ated AIEC bacteria to colonize the intestine and to induce
clinical symptoms of colitis.
Histological analyses of colonic tissues were performed at
day 7 after infection to evaluate the degree of inflammation.
In WT mice infected with AIEC LF82 bacteria, a slight poly-
nuclear infiltration was observed but colonic mucosa was nor-
mal, with the crypts being straight, well defined, and sitting
on the muscularis mucosa (Fig. 4 A). In addition, the histo-
logical score was not significantly different between nonin-
fected, E. coli K-12–infected, and AIEC LF82-infected mice
(Fig. 4 B). In contrast, histological colonic sections of AIEC
LF82-infected transgenic mice showed hemorrhagic walls
with multiple ulcerations, mucosal edema, neutrophil infiltra-
tions with transmural involvement, and presence of large ero-
sion areas (Fig. 4 C). Also, the histological score was greatly
correlated with mucosal colonization of the GI tract. At day
7 after infection, AIEC bacteria were not detected in 12 out
of 13 colonic samples of WT mice (Fig. 1 C). In contrast, we
found that a majority of transgenic mice (8/13) harbored
colon-associated AIEC LF82 bacteria, and confocal microscopy
examination of colonic sections stained for CEACAM6
showed that AIEC bacteria colocalized with CEACAM6 ex-
pression (Fig. 1 D).
AIEC LF82 GI colonization induced severe colitis in mice
expressing human CEACAMs
To analyze the consequences of AIEC LF82 colonization, we
recorded the body weight loss, survival rate, and disease ac-
tivity index (DAI) score of WT mice and CEABAC10 mice
orally challenged with 109 bacteria. None of the WT mice
challenged with AIEC LF82 or E. coli K-12 bacteria devel-
oped bloody diarrhea or appeared ill. There was a similar
evolution in body weight in both infected and noninfected
mice and no mortalities in either group (Fig. 2, A and B).
None of the E. coli K-12– and LF82-infected WT mice pre-
sented clinical symptoms of colitis, and no significant differ-
ence in DAI scores was observed between noninfected,
E. coli K-12–infected, and LF82-infected WT mice (Fig. 2 C).
In contrast, clinical symptoms of colitis were observed in
CEABAC10 mice orally challenged with AIEC LF82. At day
2, a significant (P < 0.01) decrease in body weight of mice
infected with AIEC LF82 (87.4 ± 2.0%) was observed com-
pared with noninfected transgenic mice (96.0 ± 1.6%) or
mice infected with E. coli K-12 (92.5 ± 1.5%; Fig. 2 D), a
difference which persisted until the end of the experiment.
The severity of the disease induced by AIEC infection in
transgenic mice was confirmed by a high mortality rate. In-
fection with AIEC LF82 bacteria induced a strongly reduced
survival rate from day 2 (Fig. 2 E) and, at day 7 after infec-
tion, only 20% of mice survived, whereas no mortality was
observed in noninfected transgenic mice or in those infected
with E. coli K-12 bacteria. Increased clinical symptoms of
colitis were observed in transgenic mice orally challenged
with AIEC LF82 compared with E. coli K-12 bacteria. The
Figure 3. Intraperitoneal administration of anti-CEACAM6 monoclonal antibody 24 h before infection and at days 0, 1, and 3 after infec-
tion prevents colonization and clinical symptoms of colitis in AIEC LF82-infected CEABAC10 transgenic mice. (A–C) Evolution of the number of
AIEC LF82 in the feces (A), of DAI score ascertained at days 3 and 6 after infection (B), and of body weight (C) of transgenic mice orally challenged at day
0 with 109 AIEC LF82 bacteria. Horizontal bars represent medians. CEABAC10 transgenic FVB/N mice: AIEC LF82 infected (n = 5; black triangles); AIEC LF82
infected after intraperitoneal injection of anti-CEACAM6 antibody (n = 5; black circles). Two experiments were performed independently. Shown here are
colonization, DAI, and body weight evolution of one representative experiment. Error bars represent SEM. *, P < 0.05; **, P < 0.01.
JEM VOL. 206, September 28, 2009
the LF82-fimH mutant in the stools (2.2 × 107 CFU/g of
feces) compared with WT AIEC LF82 bacteria (3.0 × 108
CFU/g of feces) was observed at day 3 after infection (P =
0.001). At day 6 after infection, a 2-log difference was ob-
served between WT LF82 bacteria and type 1 pili–negative
LF82-fimH mutant. In agreement with these results, trans-
genic mice receiving the LF82-fimH mutant, unlike those
infected with WT AIEC LF82 bacteria, had a body weight
similar to that observed for noninfected mice from day 5 after
infection (Fig. 5 B). In addition, an 85% survival rate was ob-
served for AIEC LF82-fimH mutant infected mice, com-
pared with only 20% for AIEC LF82 infected mice at day 7
after infection (Fig. 5 C). Also, mice infected with the AIEC
LF82-fimH isogenic mutant did not present any significant
difference in the DAI score compared with noninfected mice
(Fig. 5 D). Colonic examination revealed that histological
damages observed in AIEC LF82-infected transgenic mice
were no longer observed in mice infected with the LF82-
fimH mutant (Fig. 6 A). Indeed, these mice presented nor-
mal colonic histological structures with little infiltration of
inflammatory cells; the colonic histological score was signifi-
cantly (P = 0.003) decreased for mice infected with the
LF82-fimH isogenic mutant (6.8 ± 1.1) compared with
mice infected with AIEC LF82 bacteria (11.0 ± 0.4; Fig. 6 B).
increased in transgenic mice infected with LF82 (11.0 ± 0.4)
compared with noninfected mice (3.0 ± 0.7) or mice infected
with E. coli K-12 (3.0 ± 0.8), and the differences were highly
statistically significant (P < 0.001; Fig. 4 D). Epithelial damage
occurred in all areas of the colonic mucosa and the infiltrated
immune cells were mostly polynuclear cells. In addition, some
cryptic abscesses were observed in transgenic mice infected
with AIEC LF82 but not in those infected with E. coli
MG1655. These findings demonstrate that mice expressing
human CEACAMs are susceptible to AIEC LF82 oral infec-
tion and develop severe clinical symptoms of colitis.
AIEC LF82 colonization and induced colitis is dependent
on type 1 pili expression
To investigate the role of type 1 pili in AIEC bacterial colo-
nization, CEABAC10 transgenic mice were challenged with
AIEC LF82-fimH isogenic mutant, which did not produce
type 1 pili but was still able to synthesize functional flagella
(unpublished data). Analysis of the presence of AIEC LF82
bacteria or the LF82-fimH mutant in the stools revealed that
at day 2 after infection there was a statistically significant 4.5-
fold decrease (P = 0.033) in LF82-fimH mutant (7 × 107
CFU/g of feces) compared with WT AIEC LF82 bacteria
(3.2 × 108 CFU/g of feces; Fig. 5 A). A 13.6-fold decrease in
Figure 4. Intestinal colonization by AIEC LF82 bacteria causes severe histopathological damage in colonic mucosa. (A–D) Hematoxylin/eosin/
safran staining of colonic tissue sections obtained at day 7 after infection from WT mice (A) or CEABAC10 transgenic mice (C), noninfected or infected
with E. coli K-12 MG1655 or with AIEC LF82 bacteria (magnification, 100×). Histopathological scoring for several parameters of colonic inflammation was
performed for WT mice (B) or CEABAC10 transgenic mice (D), noninfected or infected with 109 E. coli K-12 MG1655 or with AIEC LF82 bacteria. WT FVB/N
mice: CMC alone (n = 11), E. coli K-12 MG1655 infected (n = 12), AIEC LF82 infected (n = 14); CEABAC10 transgenic FVB/N mice: CMC alone (n = 9), E. coli
K-12 MG1655 infected (n = 11), AIEC LF82 infected (n = 15). Shown here are representative histological scores of two separate experiments. Error bars
represent SEM. ***, P < 0.001 compared with noninfected mice. Bars, 100 µm.
CEACAM INTESTINAL EXPRESSION AND AIEC COLONIZATION | Carvalho et al.
et al., 2007; Sasaki et al., 2007; Eaves-Pyles et al., 2008). The
latter are able to adhere to and invade intestinal epithelial cells
and to replicate within macrophages, eliciting a strong pro-
inflammatory response through TNF secretion (Darfeuille-
Michaud et al., 1998; Boudeau et al., 1999; Glasser et al.,
2001). A possible explanation for the increased number of
AIEC bacteria associated with ileal mucosa is the increased
expression of CEACAM6 on the brush border of ileal en-
terocytes in CD patients because our previous in vitro studies
suggested that CEACAM6 can act as a receptor for AIEC
binding to the intestinal mucosa (Barnich et al., 2007). In this
paper, we analyzed through in vivo experiments whether
CEACAM expression can lead to abnormal colonization by
AIEC bacteria and to the development of gut inflammation.
To mimic abnormal expression of CEACAM6 observed
in CD patients, we used the transgenic CEABAC10 mouse
model expressing human CEACAMs (Chan and Stanners,
2004). Oral challenge of these mice with the AIEC reference
strain LF82 induced body weight loss, diarrhea, rectal bleed-
ing, and a greatly reduced survival rate of only 20% at day 7
after infection. Infected transgenic CEABAC10 mice, but
not WT mice, presented severe gut inflammation with in-
creased proinflammatory cytokines IL-1, IL-6, and IL-17
mRNA levels, decreased antiinflammatory cytokine IL-10
mRNA levels, and histopathological damage of gut mucosa.
As the lesions were restricted to the colonic mucosa, we
therefore further analyzed the discrepancy in the site of
Finally, significantly increased levels of IL-1, IL-6, and IL-17
mRNAs (5.5-fold, 3.4-fold, and 6.1-fold, respectively) and
significantly decreased levels of IL-10 mRNAs (5.6-fold)
were observed in colonic specimens of CEABAC10 mice
infected with AIEC LF82 bacteria compared with those of
noninfected mice (Fig. 6, C–F). In contrast, such variations
in cytokine levels were not observed after infection with the
LF82-fimH isogenic mutant. Altogether, these results rein-
force the role of type 1 pili in AIEC LF82 colonization and
reveal that only fully virulent AIEC LF82 bacteria can induce
colitis in CEABAC10 mice by increasing the expression of
Two broad hypotheses have emerged regarding the patho-
genesis of IBD. One speculates that primary dysregulation of
the mucosal immune system leads to excessive immunologi-
cal responses to normal microflora and the other suggests that
changes in the composition of gut microflora elicit patholog-
ical responses from the normal mucosal immune system (for
review see Strober et al., 2007). In the ileal involvement of
CD, changes in mucosa-associated microbiota have been ob-
served, in particular a decrease in F. prausnitzii, bacteria with
antiinflammatory properties (Sokol et al., 2008), and an in-
crease in pathogenic E. coli (Neut et al., 2002; Swidsinski
et al., 2002; Darfeuille-Michaud et al., 2004; Martin et al.,
2004; Mylonaki et al., 2005; Conte et al., 2006; Kotlowski
Figure 5. AIEC LF82 colonization via type 1 pili expression induce clinical symptoms of colitis in CEABAC10 transgenic mice. (A) Quantification
of AIEC LF82 bacteria (black triangles) or type 1 pili–negative AIEC LF82-fimH mutant (white triangles) in the feces of CEABAC10 mice after oral infection
with 109 bacteria at day 0. Each symbol represents one mouse and the horizontal bars represent the medians. (B and C) Evolution of body weight (B) and
survival rate (C) of CEABAC10 transgenic mice orally challenged at day 0 with CMC alone (black circles), CMC containing 109 AIEC LF82 bacteria (white
squares), or CMC containing 109 AIEC LF82-fimH bacteria (white triangles). (D) DAI score ascertained for CEABAC10 transgenic mice that were nonin-
fected, infected with AIEC LF82-fimH bacteria, or infected with AIEC LF82 bacteria at day 7 after infection. CEABAC10 transgenic FVB/N mice: CMC alone
(n = 9), AIEC LF82-fimH infected (n = 14), AIEC LF82 infected (n = 15). Shown here are representative body weight evolution, survival rate, and DAI of
three separate experiments. Error bars represent SEM. *, P < 0.05; **, P < 0.01; ***, P < 0.001 (compared with mice infected with AIEC LF82-fimH).
JEM VOL. 206, September 28, 2009
CEACAM6 and that the adhesion of AIEC bacteria is man-
nose dependent (Barnich et al., 2007). Among the human
CEACAM molecules expressed in the GI tract of CEA-
BAC10 mice or CD patients, we show here that in transgenic
mice expressing human CEACAMs, CEACAM6 plays a key
role. Indeed, intraperitoneal administration of anti-CEACAM6
monoclonal antibodies, by blocking the CEACAM6 recep-
tor, resulted in significant decreases in AIEC LF82 coloniza-
tion and DAI scores.
As a general rule, colonization of the gut mucosa by bac-
teria can elicit gut inflammation, but this is not observed for
Campylobacter jejuni, which failed to induce an inflammatory
response (Rinella et al., 2006; Mansfield et al., 2007). In the
present study, we observed for AIEC bacteria a strict correla-
tion between colonization and development of inflamma-
tion. Indeed, in WT mice orally challenged with AIEC LF82,
we observed neither colonization nor any sign of gut inflam-
mation. In contrast, when CEABAC10 mice were challenged
lesions between mice and CD patients because AIEC bacteria
are associated with ileitis (Darfeuille-Michaud et al., 2004).
Western blot analysis of CEACAMs expression in CEA-
BAC10 transgenic mice indicated that CEACAM5 was
highly expressed in both small intestine and colon, but that
expression of CEACAM6 was restricted to the colonic mu-
cosa (unpublished data). This confirmed the previously
reported lack of ceacam6 mRNA in the ileal mucosa of
CEABAC10 transgenic mice (Chan and Stanners, 2004).
Thus, in this mouse model challenged with AIEC bacteria,
the absence of ileal inflammation can be explained by the lack
of ileal CEACAM6 expression. These results can be corre-
lated with our previous study showing that ileal enterocytes
from CD patients overexpressed both CEACAM5 and
CEACAM6 and that the AIEC adhesion to the brush border
of enterocytes was inhibited by CEACAM6 antibodies but
not by CEACAM5 antibodies. This could be a result of
the fact that mannose-rich sugars are more prevalent on
Figure 6. Type 1 pili–dependent AIEC LF82 colonization is required to induce severe histopathological damage and inflammation of colonic
mucosa. (A) Hematoxylin/eosin/safran staining of colonic tissue sections obtained at day 7 after infection from CEABAC10 transgenic mice noninfected,
infected with AIEC LF82-fimH isogenic mutant, or infected with AIEC LF82 bacteria (magnification, 100×). (B) Histopathological scoring for several pa-
rameters of colonic inflammation. (C–F) Total RNAs from mouse colon were isolated and IL-1 (C), IL-6 (D), IL-17 (E), and IL-10 (F) mRNA levels were mea-
sured by RT-PCR. CEABAC10 transgenic FVB/N mice: CMC alone (n = 9), AIEC LF82-fimH infected (n = 14), AIEC LF82 infected (n = 15). Shown here are
representative histological scores of two separate experiments. Error bars represent SEM. *, P < 0.05; **, P < 0.01 (compared with mice infected with AIEC
LF82-fimH). Bars, 100 µm.
CEACAM INTESTINAL EXPRESSION AND AIEC COLONIZATION | Carvalho et al.
to block AIEC adhesion and therefore colonization, such as
use of probiotics and/or vaccination. Results of probiotic trials
in CD are mixed (Sartor, 2004). E. coli Nissle 1917 was more
effective than a placebo in preventing relapse of CD after in-
duction of remission by standard medical therapy (Malchow,
1997), but no benefit of Lactobacillus GG administered for 1 yr
could be demonstrated in preventing postoperative relapse of
symptoms or endoscopic lesions in the neoterminal ileum
(Prantera et al., 2002). However, the findings of the present
study suggest that probiotics, such as yeasts or cell wall man-
noprotein from yeasts, which are very rich in free mannose
residues, would be a promising strategy to inhibit AIEC colo-
nization in patients expressing CEACAM6 on the ileal mu-
cosa and harboring AIEC bacteria and, therefore, to prevent
recurrent intestinal inflammation and possibly to treat active
CD. In addition, E. coli Nissle 1917, which has a strong and
significant inhibitory effect on adherent-invasive E. coli adhe-
sion and invasion in co-infection and preinfection experi-
ments, could thus be effective for preventive or curative
probiotic therapy in patients with CD (Boudeau et al., 2003).
Adhesin-based vaccines may also be effective in the preven-
tion of CD, as previously reported for the prevention of recur-
rent and acute infections of the urogenital mucosa (Langermann
et al., 1997). It was reported for uropathogenic E. coli that an-
tibodies specifically blocking the binding of FimH to its natu-
ral receptor prevent bacterial colonization and the subsequent
inflammation of the urinary tract (Thankavel et al., 1997;
Langermann et al., 2000). A vaccine containing a recombinant
truncated form of FimH adhesin strongly reduced the in vivo
colonization of the bladder by uropathogenic E. coli in a mouse
cystitis model (Poggio et al., 2006), suggesting that a similar
approach could be used to block gut AIEC colonization in
CD patients expressing CEACAM6. Finally, another strategy
could be to interrupt pilus assembly and thereby block pilus-
mediated adhesion using pilicides, which are pilus inhibitors
with AIEC bacteria, both bacterial colonization of the co-
lonic mucosa and severe inflammation were observed. How-
ever, transgenic mice given nonpathogenic E. coli orally had
no E. coli colonization or gut inflammation. A similar absence
of colonization and inflammation was also observed when
the nonpiliated mutant of AIEC LF82, which is unable to
bind CEACAM6, was orally administered to transgenic mice.
Overall, these results indicate that for AIEC involvement in
CD the abnormal expression of CEACAM6 plays a crucial
role by allowing the bacteria to colonize the gut mucosa and,
subsequently, to trigger inflammation. It has been recently
reported that the intrusion of enteropathogens into the gut
ecosystem can result in the triggering of the host’s inflam-
matory response, which disrupts colonization resistance, as
reported for C. rodentium and Salmonella enterica serovar
Typhimurium (Lupp et al., 2007; Stecher et al., 2007). In-
flamed gut might offer altered conditions, such as a change in
the adhesion sites, that can be exploited by the pathogen but
not by the commensals. In the AIEC model, it would seem
that it is not only inflammation that promotes intestinal colo-
nization because we previously observed, using the DSS-in-
jured colon model in WT BALB/c/J mice, that infection
with AIEC LF82 bacteria significantly worsened colitis but
this inflammation did not allow the AIEC bacteria to colo-
nize the gut (Carvalho et al., 2008).
The inflammation induced by AIEC infection in CEA-
BAC10 transgenic mice was not observed when mice were
infected with the AIEC LF82 type 1 pili–negative mutant,
indicating that the adhesion of AIEC bacteria to the gut mu-
cosa via type 1 pili is essential for the development of inflam-
mation. This result is of great interest because FimH could
serve as a potent stimulator of the innate immune response
via interaction with TLR4 independently of LPS (Mossman
et al., 2008). Also, previous molecular dissections of viru-
lence factor expression in the AIEC LF82 strain suggested
that LF82 bacteria are highly flagellated and, therefore, highly
piliated under GI tract conditions as a result of a coregulation
between expression of flagella and type 1 pili (Barnich et al.,
2003; Claret et al., 2007; Rolhion et al., 2007). The results
reported in the present study showing that gut inflammation
is linked to type 1 pili expression by pathogenic E. coli corre-
lates with what was observed with uropathogenic E. coli and
urinary tract infection (Cegelski et al., 2008).
We know from various models that the binding of adhes-
ins expressed on the bacterial cell surface to defined glycosyl-
ated receptors on the host tissue surface is considered to be an
initial and critical step in pathogenesis. As AIEC bacteria have
the ability to colonize the intestinal mucosa, this opens a new
avenue for therapy such as blocking the interaction between
type 1 pili and CEACAMs. AIEC adhesion involving type 1
pili is mediated by recognition of mannose residues by the
FimH adhesion site located at the tip of the pilus (Ofek et al.,
2000). Recent crystal structure determination of FimH com-
plexed with oligomannose-3 showed the feasibility of using
natural and engineered mannose antagonists to block bacterial
invasion (Wellens et al., 2008). Several strategies can be used
Table I. DAI assessment
Body weight loss
Blood in stool
1–5% loss of body weight
5–10% loss of body weight
10–20% loss of body weight
>20% loss of body weight
Slimy diarrhea, little blood
Severe watery diarrhea with blood
Presence of blood assessed by Hemoccult II test
JEM VOL. 206, September 28, 2009
Infection of mice. 12-wk-old FVB/N WT or CEABAC10 transgenic male
mice (body weight, 26–28 g) were pretreated by oral administration of the
broad-spectrum antibiotic streptomycin (20 mg intragastric per mouse) to
disrupt normal resident bacterial flora in the intestinal tract (Wadolkowski
et al., 1988; Stecher et al., 2007) and were orally challenged with 109 bacteria
24 h later. Because we observed a very wide distribution range of the num-
bers of bacteria in the feces, as shown in Fig. S1 A, we adapted the protocol.
Animals received the very low dose of 0.25% (wt/vol) of dextran sulfate so-
dium (DSS; molecular mass = 36,000-50,000 daltons; MP Biomedicals) in
drinking water starting 3 d before infection to increase the accessibility of
bacteria to the surface of the epithelial layer. The administration of 0.25% DSS
did not affect the body weight of transgenic mice and did not induce clinical
symptoms of colitis as assessed by the DAI score (Fig. S1, B and C). When
mice attained 80% of their initial weight or 7 d after oral bacterial infection,
they were anesthetized with isoflurane and then euthanized by cervical dislo-
cation. Colon specimens were collected to quantify mucosal-associated bac-
teria, to analyze histological damages, and to perform quantitative RT-PCR.
Spleen and liver were collected to quantify translocated bacteria. To perform
anti-CEACAM6 antibody treatment, 500 µg of monoclonal anti-CEACAM6
9A6 (GENOVAC) were injected intraperitoneally in 200 µl of PBS 24 h be-
fore infection, and at days 0, 1, and 3 after infection.
Colonization evaluation. 1, 2, 3, and 6 d after bacterial infection, fresh fe-
cal pellets (100–200 mg) were collected from individual mice and resuspended
in PBS. After serial dilution, bacteria were enumerated by plating on LB agar
medium containing 50 mg/µl ampicillin and 20 mg/µl erythromycin to iso-
late AIEC LF82 bacteria and isogenic mutants, 300 mg/µl or containing ri-
fampicin to isolate K-12 MG1655 bacteria, and incubated at 37°C overnight.
that target chaperone function by inhibiting pilus biogenesis
(Svensson et al., 2001; Larsson et al., 2005). In conclusion, the
results generated by the in vivo studies reported in this paper
could lead to the development of specific therapies to treat pa-
tients with ileal involvement of CD by targeting AIEC bacte-
rial adhesion to the gut mucosa.
MATERIALS AND METHODS
Bacterial strains and culture. Ampicillin-erythromycin–resistant E. coli
strain LF82, isolated from a chronic ileal lesion of a CD patient, was used as
the AIEC reference strain (Darfeuille-Michaud et al., 1998). A nonpiliated
isogenic mutant AIEC LF82 deleted for the fimH gene and the E. coli K-12
MG1655 rifampicin-resistant strain (laboratory stock) were also used in this
study. Overnight bacterial cultures in Luria-Bertani (LB) broth without
shaking at 37°C were harvested by centrifugation at 4,000 g for 15 min. The
bacterial pellet was resuspended in carboxymethyl cellulose (CMC) at 0.5%
(wt/vol) in distilled water.
Mice. All mice were housed in specific pathogen-free conditions in the ani-
mal care facility at the University of Auvergne (Clermont-Ferrand, France).
FVB/N WT mice were purchased from Charles River Laboratories and
CEABAC10 transgenic mice (heterozygote; Chan and Stanners, 2004) were
maintained in our animal facilities. WT and transgenic CEABAC10 mice
were coupled to obtain 50% WT mice and 50% CEABAC10 mice. Mice
from the same generation were used for experimentation. Animal protocols
were approved by the Committee for Research and Ethical Issues of the In-
ternational Association for the Study of Pain.
Table II. Histological grading of intestinal inflammation
Infiltration of inflammatory cells
Infiltration of lamina propria by mononuclear cells
Infiltration of lamina propria by polynuclear cells
Infiltration of epithelium by polynuclear cells
Severity of epithelial damage
Surface of epithelial damage
Rare inflammatory cells in the lamina propria
Increased numbers of inflammatory cells, including neutrophils in the lamina propria
Confluence of inflammatory cells extending into the submucosa
Transmural extension of the inflammatory cell infiltrate
Inside the crypt
Absence of mucosal damage
Extensive mucosal damage and extension through deeper structures of the bowel wall
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Colonization was confirmed by numbering AIEC-associated bacteria to the
colonic mucosa at day 7 after infection. A 2-cm segment of colon, beginning
at 0.5 cm from the cecal junction, was removed and opened longitudinally.
The segment was placed in sterile PBS solution. The sample was homoge-
nized and the resulting suspension was plated in duplicate onto LB agar plates
containing appropriated antibiotics and incubated overnight at 37°C.
Clinical assessment of colitis and histological evaluation of colonic
damage. Colonic damage was ascertained by DAI as defined in Table I. Rec-
tal bleeding was assessed by Hemoccult II test (SKD SARL). The scores range
from 0 (healthy) to 12 (greatest activity of colitis). After mouse sacrifice, the
entire colon was excised and rolls of the proximal colon were fixed in buffered
4% formalin, paraffin embedded, cut into 3-µm slices, and stained with hema-
toxylin/eosin/safranin. The histological severity of colitis was graded in a
blinded fashion by a GI pathologist. The tissue samples were assessed for the
extent and depth of inflammation and the extent of crypt damage as presented
in Table II. The histology score corresponds to the sum of each items.
Confocal microscopy. Colonic sections taken at day 7 after infection of
WT or transgenic mice infected with AIEC LF82 were stained using mouse
anti–human CEACAM6 monoclonal antibody clone 9A6 (GENOVAC)
and Cy3-conjugated anti–mouse IgG (Vector Laboratories) as secondary an-
tibody. AIEC LF82 bacteria were detected with rabbit anti-O83 antibody
and FITC-conjugated anti–rabbit IgG (Vector Laboratories). Tissues were
observed with a confocal microscope (LSM 510 Meta; Carl Zeiss, Inc.).
mRNA quantification. Total RNA was isolated from colonic tissues using
TRIzol (Invitrogen) according to the manufacturer’s instructions. After
treatment at 37°C for 30 min with 20–50 U RNase-free DNase I (Roche),
complementary DNA were obtained using a Reverse transcription (Fermen-
tas) and were quantified in realplex2 (Eppendorf) using SYBR green Taq
ReadyMix (Sigma-Aldrich) with specific mouse oligonucleotides. The sense
and antisense oligonucleotides used were, respectively, the following:
GAPDH, 5-ATGGCCTTCCGTGTTCCTAC-3 and 5-CAGAT-
GCCTGCTTCACCAC-3; IL-1, 5-ATGGCAACTGTTCCTGAACT-
CAACT-3 and 5-CAGGACAGGTATAGATTCTTTCCTTT-3; IL-6,
5-CTAGGTTTGCCGAGTAGATCT-3 and 5-CACAAAGCCAGAG-
TCCTTCAGAGA-3; IL-17, 5-ACCTCACACGAGGCACAAGTG-3
and 5-CTTCATTGCGGTGGAGAGTCC-3; and IL-10, 5-CCCTTT-
GCTATGGTGTCCTT-3 and 5-TGGTTTCTCTTCCCAAGACC-3.
Each sample was run in duplicate. All results were normalized to the unaf-
fected housekeeping GAPDH gene.
Statistical analysis. Statistical analysis was performed using a two-tailed Fisher’s
exact test. A p-value 0.05 was considered statistically significant. Data are ex-
pressed as the mean ± SEM. ANOVA was used for intergroup comparison.
Online supplemental material. Fig. S1 presents data of AIEC LF82
bacterial colonization, evolution of body weight, and DAI according to
CEACAM expression in mice receiving or not 0.25% of DSS in drink-
ing water. Online supplemental material is available at http://www.jem
We thank Dr Abdelkrim Alloui for animal care (Animal facilities, Clermont-Ferrand,
France). The authors are grateful to Pierre Sauvanet and Frédéric Faure (JE2526,
Clermont-Ferrand, France) and Monique Etienne (Institut National de la Santé et de
la Recherche Médicale U766, Clermont-Ferrand, France) for technical assistance.
This study was supported by the Ministère de la Recherche et de la Technologie
(JE2526), Institut National de la Recherche Agronomique (Unité Sous Contrat 2018),
and by grants from the Association F. Aupetit, Institut de Recherche des Maladies de
l’Appareil Digestif (Laboratoire Astra France), and European Commission through
FP7 IBDase project.
The authors have no conflicting financials interests.
Submitted: 2 April 2009
Accepted: 20 August 2009
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