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Published online before print December 23, 2004

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© by The Society for Leukocyte Biology
Journal of Leukocyte Biology, doi:10.1189/jlb.0904543

Received for publication September 22, 2004.
Revised October 28, 2004.
Accepted for publication December 3, 2004.

Article

Defensin deficiency, intestinal microbes, and the clinical phenotypes of Crohn’s disease

Jan Wehkamp ^*@, Michael Schmid , Klaus Fellermann , and Eduard F. Stange

*Department of Microbiology and Immunology, University of California, Davis; and Department of Internal Medicine I, Robert Bosch Hospital and Dr. Margarete Fischer Bosch Institute, Stuttgart, Germany

	Abstract

Crohn’s disease is a chronic, inflammatory disease of the intestinal mucosa. Although intestinal bacteria are implicated in disease pathogenesis, the etiology is still unclear. The main location of disease is the small intestine (ileum) and the colon. Ileal disease has been linked to a mutation in the NOD2 gene. Defensins are antimicrobial peptides and in the ileum, are mainly expressed in Paneth cells, epithelial cells that also express NOD2. In the colon, defensins are expressed by enterocytes or metaplastic Paneth cells. Crohn’s disease patients with ileal involvement, compared with controls or Crohn’s patients without ileal involvement, have diminished expression of ileal Paneth cell defensins. This decrease is even more pronounced in Crohn’s patients displaying a NOD2 mutation. In contrast, Crohn’s disease of the colon is characterized by an impaired induction of -defensins in enterocytes. The colonic expression of the constitutive -defensin 1 is also decreased in the inflamed colonic mucosa, but this decrease is less specific to Crohn’s disease, as it can also be found in ulcerative colitis patients. In conclusion, the regional localizations of Crohn’s disease, ileal or colonic disease, can be linked to different defensin profiles. Crohn’s disease of the ileum is associated with diminished defensin expression in Paneth cells. Crohn’s disease of the colon is associated with diminished -defensin expression in enterocytes. Thus, it can be speculated that decreased defensin levels lead to a weakened intestinal barrier function to intestinal microbes and might be crucial in the pathophysiology of Crohn’s disease.

Key Words: NOD2 • Paneth cells • probiotic bacteria • E. coli Nissle 1917

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