Abstract
Background:Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, categorized into various subtypes. Post-infection IBS may be attributed to the release of cytolethal distending toxin B (CdtB), which cross-reacts with the adhesion protein vinculin responsible for normal intestinal contractility.Objective:This study aims to identify anti-CdtB and anti-vinculin levels in IBS patients compared to healthy control.Subjects and methods:This retrospective case-control study was conducted on 100 subjects with IBS, as determined by a questionnaire based on Rome III criteria, recruited from the outpatient clinics of the Tropical Medicine at Mansoura University Hospital from January 2019 to January 2020.Results:Anti-vinculin and anti-CdtB levels were significantly elevated in patients with IBS (1.58±0.496, 2.47±0.60) when compared to control subjects (1.13±0.249ng/ml, 2.1±0.24 ng/ml), respectively with P=0.001 for both. Anti-vinculin level was significantly higher in the IBS-D subtype than the other subtypes (P=0.001) while, Anti-CdtB was significantly elevated in IBS-C, IBS-D subgroups compared to control subjects (P=0.001).Conclusion:Findings of the present study support the hypothesis that IBS results from post-infectious disorders initiated by bacterial enteritis. A hypothesis could be applied to all IBS subgroups. On the other hand. These biomarkers might reflect the post-infectious state's severity.
Highlights
The third aliquot was overlaid on heparin for plasma separation, and the remaining sera were stored at -20°C to be used for evaluation of anti-vinculin antibodies by laboratory prepared enzyme-linked immunosorbent assay (ELISA) and anti-cytolethal distending toxin B (CdtB) antibodies by commercial ELISA (Creative Diagnostics. 45-16 Ramsey Road Shirley, NY 11967, USA)
Anti-vinculin and anti-CdtB levels were significantly elevated in Irritable bowel syndrome (IBS) patients (1.58 Æ 0.496ng/ml and 2.47 Æ 0.60 ng/ml) respectively compared to the control subjects (1.13 Æ 0.249 ng/ml and 2.1 Æ 0.24 ng/ml) respectively with P = 0.001 for both (Table 2)
The level of anti-CdtB in IBS-M was detected at a non-significant lower level compared to control subjects (P = 0.2), but at a significantly lower level when compared to IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D) (P = 0.001) (Table 3)
Summary
Paragraph 01: ○ “IBS mainly manifests in subjects with abdominal pain and bowel habit changes in the absence...”○ In between Paragraph 01 and 02, authors should present info about IBS subtypes.Paragraph 02: ○ “Irritable bowel syndrome” needs to be substituted by IBS.○ “In these studies, progression to IBS was accompanied by the detection of circulating levels of a specific bacterial toxin named cytolethal distending toxin B (CdtB), a potential factor attributing to the pathogenesis of PI-IBS.”○ “This was supported by the low incidence of IBS in patients infected with a mutant strain of C. jejuni that lacks CdtB.” These studies were based on results in rats, not patients.Paragraph 03: ○ “These findings were linked to the ability of anti-CdtB to cross-react with vinculin, a host cell adhesion protein present in interstitial cells of Cajal and the myenteric ganglia that control the normal activity of the intestinal tract, including phase III of inter-digestive motor activity.”○ “Based on these data, it has been suggested that loss of vinculin in the neuromuscular system of the GIT may be associated with the affection of the gut in animal models of postinfection C. jejuni.” This statement needs a reference. ○ “This was supported by the low incidence of IBS in patients infected with a mutant strain of C. jejuni that lacks CdtB.”. These studies were based on results in rats, not patients. ○ “Based on these data, it has been suggested that loss of vinculin in the neuromuscular system of the GIT may be associated with the affection of the gut in animal models of postinfection C. jejuni.” Results: Anti-vinculin and anti-CdtB levels were significantly elevated in patients with IBS (1.58±0.496, 2.47±0.60) when compared to control subjects (1.13±0.249ng/ml, 2.1±0.24 ng/ml), respectively with P=0.001 for both. Conclusion: Findings of the present study support the hypothesis that version 4 (revision)
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