A possible link between Crohn's disease and ankylosing spondylitis via Klebsiella infections

Clin Rheumatol. 2007 Mar;26(3):289-97. doi: 10.1007/s10067-006-0391-2. Epub 2006 Aug 29.


Crohn's disease (CD) is an immune-mediated gastrointestinal inflammatory disease, which could arise from an interplay between genetic and environmental factors. Klebsiella microbes were suggested to have a vital role in the initiation and perpetuation of the disease through the mechanism of molecular mimicry. This proposition is based on the results of various studies where significantly elevated levels of antibodies against the whole bacteria or preparations from Klebsiella microbes and antibodies to collagen types I, III, IV, and V were detected in patients with CD and patients with ankylosing spondylitis (AS). Molecular similarities were found between Klebsiella nitrogenase and HLA-B27 genetic markers and between Klebsiella pullulanase and collagen fibers types I, III, and IV. Furthermore, significantly positive correlations and cross-reactivity binding activities were observed between anti-Klebsiella and anticollagen antibodies among patients with CD and AS. Early treatment of CD patients with anti-Klebsiella measures is proposed, which may involve the use of antibiotics and low starch diet together with other traditionally used immunomodulatory, immunosuppressive, or biologic agents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Bacterial / immunology
  • Crohn Disease / immunology
  • Crohn Disease / microbiology*
  • Humans
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / immunology*
  • Molecular Mimicry
  • Spondylitis, Ankylosing / immunology
  • Spondylitis, Ankylosing / microbiology*


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Antibodies, Bacterial