title: Granulomas of intestinal tuberculosis and Crohn's disease can be differentiated by CD73 cell surface marker expression: a pilot study.
abstract: BACKGROUND
  Intestinal tuberculosis (ITB) and Crohn's disease are similar granulomatous disorders. Granulomas are present in both and difficult to differentiate on histopathology alone. A recent study demonstrated recruitment of mesenchymal cells (MSCs) at the periphery of granulomas in lymph node tuberculosis which suppressed T cell responses. We hypothesized that granulomas of ITB would also recruit MSCs to evade host immune response.
  
  
  OBJECTIVE
  The purpose of this study was to demonstrate MSC markers in granulomas of ITB and evaluate whether distribution of MSC markers could differentiate between granulomas of Crohn's and ITB.
  
  
  METHODS
  We initially retrospectively enrolled 17 patients with confirmed ITB (8) or Crohn's (9) with granulomas on histopathology. Tissues were evaluated by immunofluorescence for MSC markers CD29, CD90, CD73 and absence of haematopoietic markers CD31, CD34, CD45 and CD14. Double-staining was done to confirm presence of MSCs. Subsequently, 23 postoperative specimens of Crohn's (18) and ITB (5) were analyzed for validation.
  
  
  RESULTS
  Overall, 27 Crohn's and 13 ITB cases were assessed. CD29 and CD90 positive cells were noted around both ITB and Crohn's granulomas. MSC marker CD73 was expressed around the granulomas of ITB alone and was completely absent in the Crohn's. The subsequent assessment of granulomas in postoperative specimens of Crohn's and ITB also showed similar results.
  
  
  CONCLUSIONS
  Granulomas of ITB and Crohn's disease can be differentiated by CD73 MSC surface marker expression. The differential CD73 expression around ITB granuloma indicates that Mycobacterium tuberculosis evades host immunity by recruiting MSCs with CD73 expression. MSCs with increased CD73 expression could be the future for therapeutic intervention in Crohn's.
authors.affiliation: Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, India.
authors.forename: Rupa
authors.initials: R
authors.lastname: Banerjee
authors.forename: M
authors.initials: M
authors.lastname: Balaji
authors.forename: M
authors.initials: M
authors.lastname: Sasikala
authors.forename: S
authors.initials: S
authors.lastname: Anuradha
authors.forename: G V
authors.initials: GV
authors.lastname: Rao
authors.forename: D
authors.initials: D
authors.lastname: Nageshwar Reddy
mesh_terms: D015720:5'-Nucleotidase / Q000235:genetics / Q000378:metabolism*; D015415:Biomarkers; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D058851:GPI-Linked Proteins / Q000235:genetics / Q000378:metabolism; D005786:Gene Expression Regulation / Q000502:physiology; D006099:Granuloma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D059630:Mesenchymal Stem Cells / Q000378:metabolism; D010865:Pilot Projects; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology
chemical_list: D015415:Biomarkers; D058851:GPI-Linked Proteins; D015720:5'-Nucleotidase; C548241:NT5E protein, human