IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Clin Exp Med 2010;4(3):179-186

Original Article
Differential expression of TLR2, TLR4 and JNK in mucosa of ileal pouches for
ulcerative colitis. Is there a role for bacterial antigen pathway in asymptomatic

Nielce M. de Paiva, Maria L. S. Ayrizono, Marciane Milanski, Andressa Coope, Luiza M. F. Oliveira, João J. Fagundes, Lício A. Velloso,
Cláudio S. R. Coy, Raquel F. Leal

Coloproctology Unit of the Surgery Department, University of Campinas (UNICAMP), Medical School, São Paulo, Brazil; Internal
Medicine Department, Cellular Signalization Laboratory, University of Campinas (UNICAMP), Medical School, São Paulo, Brazil.

Received June 15, 2011; accepted August 26, 2011; Epub September 15, 2011; published September 30, 2011

Abstract: Introduction: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical procedure for patients with refractory ulcerative
colitis (UC) and familial adenomatous polyposis (FAP). However, pouchitis is the most common complication after IPAA in UC patients
and only occurs after ileostomy closure. Therefore, it is important to get more information about the role of the ileal pouch microbiota
and mucosa susceptibility to inflammation in UC patients. Therefore, we evaluated Toll-like receptors (TLRs) expression in normal
endoscopic and histological mucosa of the ileal pouch in patients with UC and FAP, in order to find any abnormality in this pathway in
asymptomatic patients, which may contribute to pouchitis. Materials and Methods: Twelve patients (six with UC and six with FAP) with
“J” pouch reconstruction, after total rectocolectomy, were studied. Biopsies were obtained from the mucosa of the pouch. Normal ileum
biopsies were obtained from six patients submitted to ileocolonoscopy with no abnormalities. The specimens were snap-frozen and
the expressions of TLR2, TLR4 and JNK (nuclear signalization factor) were determined by immunoblot protein extract. Results: Patients
with UC had significantly higher protein levels of TLR4 than controls and FAP. The expressions of TLR2 and JNK were similar in the
groups. Conclusion: Patients with UC had higher levels of TLR4, even in the absence of clinical, endoscopic and histological pouchitis.
These findings may explain a tendency towards the up-regulation of intracellular pathways activated by bacterial antigens in UC
patients, which could contribute to the production of proinflammatory mediators and pouchitis development. (IJCEM1106002).

Key words: Toll-like receptors, cytokines, ileal pouch, pouchitis, ulcerative colitis, familial adenomatous polyposis

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Address all correspondence to:
Raquel F. Leal, PhD
Rua Patativa, 170, apto 24C, Bonfim – CEP 13034-810,
Campinas, São Paulo, Brazil.  
Tel + 55-19-91375374.
E-mail: raquelleal@mpc.com.br