title: Assessment of microbiota and peptidoglycan in perianal fistulas.
abstract: Transanal advancement flap repair has been advocated as the treatment of choice for high transsphincteric perianal fistulas, but fails in 1 of every 3 patients. Persistence of the fistula after flap repair might be the result of ongoing disease in the remaining fistula tract. In 10 specimens of the distal part of the fistula, microbiota was assessed by means of conventional microbiological culture and 16S rRNA gene sequencing. Proinflammatory bacterial peptidoglycan and recognition proteins were assessed by immunohistochemistry. Bacterial species were bowel derived, skin derived, or a combination of both. No mycobacterium species were identified. 16S rRNA gene sequencing failed to identify bacteria in all but 1 specimen, most likely as a result of low numbers of organisms. Peptidoglycan was detected in 90% of the patients, and a host response to peptidoglycan in 60%. Therefore, we suggest that peptidoglycan might play a role in the ongoing inflammation in perianal fistulas.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: van Onkelen
authors.forename: L E
authors.initials: LE
authors.lastname: Mitalas
authors.forename: M P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: A
authors.initials: A
authors.lastname: van Belkum
authors.forename: J D
authors.initials: JD
authors.lastname: Laman
authors.forename: W R
authors.initials: WR
authors.lastname: Schouten
mesh_terms: D000328:Adult; D001419:Bacteria / Q000737:chemistry* / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D001431:Bacteriological Techniques; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010457:Peptidoglycan / Q000032:analysis*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012003:Rectal Fistula / Q000382:microbiology*; D017422:Sequence Analysis, DNA
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D010457:Peptidoglycan; D012336:RNA, Ribosomal, 16S