Differentiation between ulcerative colitis and Crohn's disease by a quantitative immunohistochemical evaluation of T lymphocytes, neutrophils, histiocytes and mast cells

Abstract Background Intestinal resection in Crohn’s disease (CD) is not curative and the risk for postoperative recurrence (POR) remains high. Highlighting risk factors for POR is crucial for the postoperative management of CD patients. Myenteric plexitis is a well-established risk factors for POR. The primary purpose of this study was to evaluate the correlation of neuropeptide P (NPY)-, vasoactive intestinal peptide (VIP)- and substance P (SP)-ergic nerve density with the presence and severity of plexitis in myenteric and submucosal plexuses in the proximal resection margin. Secondary aims were to assess the value of abovementioned neuropeptides’ expression in predicting POR and to recognize additional risk factors. Methods We conducted a retrospective, single-center study on CD patients who underwent ileocolonic resection (ICR) between January 2010 and December 2016. Exclusion criteria were age <16 years, patients with missing or invalid data precluding analysis, the presence of a diverting ileostomy on enrollment and specimens inappropriate for the evaluation of histologic features of interest in the proximal resection margin. Demographic and clinical data were retrieved, and the incidence or endoscopic, clinical and surgical POR was recorded. The presence and severity of plexitis was evaluated by hematoxylin and eosin staining. Giemsa staining was used for the recognition of mast cells. Immunohistochemistry was used was used for the detection of T-lymphocytes and NPY-, VIP- and SP-ergic neurons. The expression of the above peptides was quantified using image analysis. Results Seventy-nine patients (44 males) with a median age of 35 years were included. The median follow-up was 71 months. Myenteric and submucosal plexitis were present in 83.5% and 73.4% of patients, respectively. No association was detected between the density of NPY, VIP and SP expression and the presence or severity of plexitis. Similarly, the number of the involved T-lymphocytes or mast cells was not correlated with the expression of these peptides. Univariate and multivariate Cox proportional regression analysis was performed for the detection of risk factors for POR. Smoking and moderate/severe myenteric plexitis were independent risk factors for endoscopic and clinical POR, whereas an involved ileal margin was recognized as a risk factor for clinical POR. Conclusion This study did not document a correlation between plexitis in proximal resection margin and the expression of specific neuropeptides. According to our findings, smoking, myenteric plexitis, and involved ileal margin are independent risk factors for POR.

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Phenotypic profile of peripheral blood lymphocytes in patients with inflammatory bowel diseases

Medical Immunology (Russia) ◽

10.15789/1563-0625-ppo-2080 ◽

2021 ◽

Vol 22 (6) ◽

pp. 1131-1140

Author(s):

M. M. Zafranskaya ◽

H. Yu. Adamovich ◽

A. U. Varabei ◽

A. M. Starastin ◽

D. B. Nizheharodava

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

T Lymphocytes ◽

Crohn's Disease ◽

Inflammatory Bowel Diseases ◽

Peripheral Blood ◽

Cell Receptor ◽

Peripheral Blood Lymphocytes ◽

Bowel Diseases ◽

Inflammatory Bowel

Mechanisms of recognition and effector responses of immune system upon initiation and maintenance of immune-mediated inflammation and tissue damage in inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis (UC), have been actively studied over recent time. Existing evidence suggests these diseases to be caused by abnormal immune response against intestinal flora microorganisms in genetically susceptible individuals. Despite available data on the features of immune disorders in ulcerative colitis and Crohn’s disease, there are still many questions about the involved minor lymphocyte subpopulations and contribution of various functionally active molecules, which play a key role in recognition and initiation of the immune response and can be considered biomarkers of a pathological process in inflammatory bowel diseases. The populations of T lymphocytes with γδT cell receptor, B1 cells and NK T lymphocytes are of greatest interest, as well as functionally active TLRs (Toll-like receptors), CD89, CD314, etc. Due to substantial progress in studying the nature of recognition and activation of the immune cells, the paper presents phenotypic and functional characteristics of major and minor subpopulations of peripheral blood lymphocytes observed in 25 patients treated at the Surgery Department of the State Institution “Minsk Regional Clinical Hospital” (Republic of Belarus) from 2018 to 2020. The detected changes in peripheral blood lymphocyte phenotype of inflammatory bowel diseases patients suggest distinct immunological profiles prevailing in the damage mechanisms in Crohn’s disease and ulcerative colitis. I.e., in Crohn’s disease patients, B1 lymphocytes with CD19+CD5+ and NK cells in combination with increased CD56bright population, as well as NK T cells with anti-inflammatory and regulatory activity are involved into genesis of the disease. In ulcerative colitis, T, B, NK lymphocytes with pro-inflammatory phenotype and T lymphocytes with γδ T cell receptor may play a pathogenetic role in maintenance of chronic inflammation. With respect to functional significance of activating receptors, the number of TLR4- и CD89-positive cells may be used for developing immunological criteria/ biomarkers of therapeutic efficacy of new drugs. Studying interactions between innate and adaptive immunity will open new perspectives in understanding immunological disorders associated with chronic gastrointestinal inflammation.

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