Prevalence and association of pks⁺ Escherichia coli with colorectal cancer in patients at the University Malaya Medical Centre, Malaysia

Escherichia coli (E. coli) from the B2 phylogenetic group is implicated in colorectal cancer (CRC) as it possesses a genomic island, termed polyketide synthetase (pks), which codes for the synthesis of colibactin, a genotoxin that induces DNA damage, cell cycle arrest, mutations and chromosomal instability in eukaryotic cells. The aim of this study was to detect and compare the prevalence of E. coli expressing pks (pks⁺ E. coli) in CRC patients and healthy controls followed by investigating the virulence triggered by pks⁺ E. coli using an in-vitro model. Mucosal colon tissues were collected and processed to determine the presence of pks⁺ E. coli. Thereafter, primary colon epithelial (PCE) and colorectal carcinoma (HCT116) cell lines were used to detect cytopathic response to the isolated pks⁺ E. coli strains. Our results showed 16.7% and 4.3% of CRC and healthy controls, respectively were pks⁺ E. coli. Further, PCE displayed syncytia and cell swelling and HCT116 cells, megalocytosis, in response to treatment with the isolated pks⁺ E. coli strains. In conclusion, pks⁺ E. coli was more often isolated from tissue of CRC patients compared to healthy individuals, and our in-vitro assays suggest these isolated strains may be involved in the initiation and development of CRC.