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P697. Candida albicans colonization and anti-glycan antibodies in active and quiescent Crohn's disease

R. Gerard1, B. Sendid2, A. Techy1, G. Vernier-Massouille1, T. Jouault2, N. Francois2, J.-F. Colombel1, D. Poulain2, 1Université Lille Nord de France, Clinique des maladies de l'appareil digestif, Hôpital Huriez, Inserm U995, CHRU de Lille, Gastroenterology, Lille, France, 2Université Lille Nord de France, Laboratoire de Parasitologie Mycologie, Inserm U995, CHRU de Lille, Parasitology-Mycology, Lille, France

Background

Recent experimental data have further suggested that apart from bacteria, the mycobiome may have a role in intestinal inflammation [1]. Anti-glycan antibodies including ASCA, which are highly prevalent in Crohn's disease (CD), are directed against cell wall yeast antigens [2]. Here we performed longitudinal study of yeast colonization in the stools in parallel with determination of anti-glycan antibodies in sera during active and quiescent CD.

Methods

Stool samples and sera were collected from 22 patients with CD in acute (Harvey–Bradshaw index [HBI] >6 and CRP >6 mg/l) and in remission phases (HBI <4 and CRP <6 mg/l). Yeasts were isolated by usual mycological procedures and identified by API 32C system. The number of colony forming units (CFUs) was assessed semi-quantatively as follows: low (1–5 CFU), medium (5–20 CFU), high (20–50 CFU), and very high (>50CFU). Serum samples were tested for anti-glycan antibodies: ASCA, ALCA, ACCA and AMCA by enzyme liked immunosorbent assay (IBDX® panel, Glycominds, Israel), and for anti-Candida mannan antibodies (Platelia Candida Ab, Bio-Rad, France).

Results

All together yeasts were detected in 68% of patients during the acute phase and 66% during remission and 81% of patients were colonized at least once during the follow-up. C. albicans was the most commonly isolated yeast species representing 96% of isolated yeast species in all patients. One patient was colonized by C. parapsilosis and 3 patients had mixed colonization associating C. albicans with C. kefyr and C. glabrata. During the acute phase, 8/22 (36%) patients had a very high colonization level (CFU > 50) as compared to 2/22 (9%) during remission (p < 0.03). Seven out of the 8 patients who were heavily colonized (CFU > 50) during the active phase had a decreased colonization level during the remission phase. There was no difference as far as gender, disease duration, disease behavior and location between these 8 patients and the others. Anti-glycan and anti-Candida antibodies status were stable during active versus quiescent disease and anti-glycan antibodies levels did not change significantly.

Conclusion

CD patients are frequently colonized by C. albicans and are more heavily colonized in active than in quiescent phase of the disease while the antiglycan antibodies status is not influenced by disease activity. Colonization by C. albicans may participate in triggering intestinal inflammation in CD.

1. Iliev ID, et al. Science 2012.

2. Poulain D, et al. Dig Dis 2009.