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Crohn's disease: NOD2, autophagy and ER stress converge
  1. Teresa Fritz1,
  2. Lukas Niederreiter1,
  3. Timon Adolph1,
  4. Richard S Blumberg2,
  5. Arthur Kaser1
  1. 1Department of Medicine II (Gastroenterology & Hepatology), Innsbruck Medical University, Innsbruck, Austria
  2. 2Division of Gastroenterology, Hepatology and Endoscopy, Dept of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Arthur Kaser, Department of Medicine II, (Gastroenterology & Hepatology), Anichstr 35, A-6020 Innsbruck, Austria; arthur.kaser{at}


Polymorphisms in NOD2, encoding an intracellular pattern recognition receptor, contribute the largest fraction of genetic risk for Crohn's disease among the >40 risk loci identified so far. Autophagy plays a prominent role in the innate immune response towards intracellular bacteria. The discovery of the autophagy genes ATG16L1 and IRGM as risk factors for Crohn's disease turned autophagy into the spotlight in inflammatory bowel disease (IBD). Remarkably, NOD2 has recently been identified as a potent autophagy inducer. A physical interaction of NOD2 and ATG16L1 appears to be required for autophagic clearance of intracellular pathogens. Moreover, Crohn's disease-associated NOD2 and ATG16L1 variants exhibit a defect in the induction of an autophagic response and hence predict autophagy as a key converging mechanism that leads to Crohn's disease. Another pathway that is closely intertwined with autophagy and mutually cross-regulated is the unfolded protein response (UPR), which is induced by endoplasmic reticulum (ER) stress. Genes involved in the UPR (XBP1, ORMDL3) have also been genetically associated with Crohn's disease and ulcerative colitis. Moreover, the intestinal epithelium at the interface between host and microbe appears particularly affected by IBD-associated hypomorphic function of autophagy and the UPR. The functional convergence of main genetic risk factors for IBD on these innate immune pathways has hence important implications for the host's interaction with the microbiota. Moreover, the genetic convergence on these molecular mechanisms may open novel therapeutic options for IBD that deserve further exploration.

  • Crohn's disease

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  • Div of Gastroenterology and Hepatology, Dept of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Ave, Cambridge CB2 0QQ, United Kingdom; ak729{at}

  • Funding Work in the authors' laboratories is supported by the Austrian Science Fund (P21530 and START Y446 to A.K.), Innsbruck Medical University (grant 407 to A.K.), the European Research Council under the European Community's Seventh Framework Programme (FP7/2007-2013)/ERC Grant agreement n 260961 (AK), the National Institutes of Health (RO1s DK088199, DK44319, DK53056 and DK51362 to R.S.B.) and the Harvard Digestive Diseases Center (DK034854 to RSB).

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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