Ulcer associated cell lineage glands expressing trefoil peptide genes are induced by chronic ulceration in ileal pouch mucosa.
BACKGROUND
Chronic ulcerative conditions in the gastrointestinal tract result in the appearance of the ulcer associated cell lineage (UACL). The glands of this new cell lineage secrete epidermal growth factor, transforming growth factor alpha, and the trefoil factor family (TFF) peptides, which are known to participate in repair processes. Pouchitis is the most frequent complication of ileal pouch-anal anastomosis.


OBJECTIVE
Our aim was to determine whether the mucosal ulceration present in pouchitis can induce the development of UACL glands.


METHODS
Biopsies from ileal pouches with pouchitis (n=10), healthy pouches (n=5), and normal terminal ileum (n=5) were studied. Expression of TFF mRNA was assessed by in situ hybridisation. TFF1 and TFF2 proteins were localised by immunochemistry.


RESULTS
UACL glands containing TFF1 and TFF2 were observed in six patients with pouchitis. In some glands, there was TFF3 mRNA as has been reported for Crohn's UACL. None of the biopsies from ileal reservoirs without pouchitis showed UACL glands (p<0.05). Neither TFF1 nor TFF2 expression was detected in ileal reservoirs without pouchitis.


CONCLUSIONS
UACL glands arise de novo in ileal pouch mucosa of patients with pouchitis and express all three TFF peptide genes. Chronic inflammation alone, present in healthy pouches, is not enough to stimulate the growth of the UACL, and additional stimuli consequent on ulceration may be needed.
Pera
M
M
Department of Surgery, Mayo Clinic Scottsdale, Arizona, USA. 28370mpr@comb.es
Heppell
J
J
Poulsom
R
R
Teixeira
F V
FV
Williams
J
J
D001345:Autoradiography; D001706:Biopsy; D016022:Case-Control Studies; D019070:Cell Lineage / Q000502:physiology*; D002908:Chronic Disease; D006801:Humans; D017403:In Situ Hybridization; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology*; D010437:Peptic Ulcer / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D010455:Peptides / Q000378:metabolism*; D019449:Pouchitis / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D012333:RNA, Messenger / Q000032:analysis; D000071164:Trefoil Factor-2
D010455:Peptides; D012333:RNA, Messenger; C000604007:TFF2 protein, human; D000071164:Trefoil Factor-2