Review in DepthRole of Klebsiella and collagens in Crohn's disease: a new prospect in the use of low-starch dietRashid, Tahaa; Ebringer, Alana b; Tiwana, Harmalea; Fielder, Markc Author Information aSchool of Biomedical and Health Sciences, Kings College London bDepartment of Rheumatology, Middlesex Hospital, University College, London cSchool of Life Sciences, Kingston University, Kingston upon Thames, Surrey, UK Correspondence to Alan Ebringer, MD, FRCP, FRACP, FRCPath, Professor of Immunology, School of Biomedical and Health Sciences, King's College London, London SE1 9NN, UK Tel: +4 207 8484302; fax: +4 207 8484500; e-mail: [email protected] Received 18 April 2008 Accepted 15 August 2008 European Journal of Gastroenterology & Hepatology 21(8):p 843-849, August 2009. | DOI: 10.1097/MEG.0b013e328318ecde Buy Metrics Abstract Crohn's disease is suggested to result from a microbially triggered immune-mediated autoimmune process, involving mainly the terminal ileum and ileo-caecal junction. Klebsiella pneumoniae shares certain molecular structures present in pullulanase pulA and pulD secretion enzymes with various self-antigens present in collagens and HLA-B27 molecules, respectively. A link exists between high dietary starch intake and the growth of intestinal microflora, involving especially Klebsiella microbes. Increased exposure to Klebsiella in the gut as the result of high starch intake would lead to high production of antiKlebsiella antibodies as well as autoantibodies to the cross-reactive self-antigens with the resultant inflammation at the pathological sites. Eradication of these microbes from the gut in patients with Crohn's disease with the use of low-starch diet and antibacterial agents as well as immunomodulatory measures could be beneficial in the management of this disease. © 2009 Lippincott Williams & Wilkins, Inc.