Impact of dietary emulsifiers on the presence of adherent-invasive Escherichia coli in Crohn’s disease

Adherent-invasive Escherichia coli (AIEC) has been implicated in Crohn’s disease (CD) pathogenesis. We aimed to evaluate the impact of dietary factors on the presence of AIEC in patients with CD and to identify AIEC-associated mucosa microbial signatures in regions with different urbanization levels. A total of 112 CD patients and healthy controls were recruited from a rural area in China (Yunnan). Clinical demographics, food additive questionnaires, and ileal biopsies were collected from subjects in rural China. AIEC was isolated from biopsy samples by an antibiotic protection assay. Correlation between AIEC presence and food additives was evaluated using multivariate logistic regression. In addition, a secondary dataset of an urban CD cohort (Hong Kong) was included for microbiome analysis. AIEC was detected in the ileal mucosa in 20.83% of patients with CD in rural China. Multivariate analysis showed that living in an urban area was associated with the presence of AIEC in CD patients. Carrageenan consumption was positively correlated with AIEC presence in CD. AIEC-positive CD patients with primary education consumed more carrageenan than AIEC-negative CD patients (p=0.008). AIEC presence in CD patients was associated with 23 microbial genera in both urban and rural areas. AIEC-positive CD patients showed a decrease in anti-inflammatory pathways. AIEC colonizes the gut mucosa of CD patients in a rural area of China, with its presence significantly associated with higher carrageenan consumption. These findings suggest a potential link between dietary emulsifiers, microbial dysbiosis, and AIEC-related CD pathogenesis.