Epithelial Cell Extrusion Zones Observed on Confocal Laser Endomicroscopy Correlates with Immunohistochemical Staining of Mucosal Biopsy Samples.
The density of epithelial cell extrusion zones in the intestinal lining, also known as gap density (number of gaps/1000 epithelial cells counted), can be quantitated using probe-based confocal laser endomicroscopy (pCLE). Gap density has been reported to be higher than normal in both inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) patients. Epithelial cells destined for extrusion from the intestinal surface would stain positive for either activated caspase-1 or caspase-3 on mucosal biopsy samples. The aim of this study was to determine whether epithelial gap density on pCLE correlates with quantitative analysis of activated caspase staining of mucosal biopsy samples from patients.



We obtained pCLE images and biopsy samples of the terminal ileum during colonoscopies of healthy controls and patients with either IBD or IBS. The pCLE images and biopsy samples were blindly analyzed for gap density and for cells staining positive for activated caspases, respectively. The degree of correlation was determined using nonparametric statistical tests.



The median results were 10 gaps/1000 cells counted for controls versus 33 gaps/1000 cells counted for chronic intestinal disorder patients (p = 0.02). Activated caspase staining showed 13 positive cells/1000 epithelial cells counted versus 26 positive cells/1000 epithelial cells counted, respectively (p = 0.02), thus showing a strong correlation with a Spearman's coefficient ρ of 0.61 (strong correlation for ρ = 0.4-0.75, p = 0.01).



Intestinal epithelial gap density via pCLE correlated strongly with quantitative analysis of immunohistochemical staining of mucosal biopsy samples.
Division of Gastroenterology, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, USA. julia.liu@ualberta.ca.|Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Shorey S8/62, Little Rock, AR, 72205, USA. julia.liu@ualberta.ca.
Julia J
JJ
Liu
Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
Theresa M
TM
Kay
Division of Gastroenterology, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
Elisabeth M
EM
Davis
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Yuefei
Y
Lou
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Dina
D
Kao
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Brian
B
Claggett
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Richard N
RN
Fedorak
Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.
Randall T
RT
Irvin
D000328:Adult; D000368:Aged; D020169:Caspases / Q000378:metabolism; D015331:Cohort Studies; D004847:Epithelial Cells / Q000502:physiology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D007082:Ileum / Q000473:pathology; D007150:Immunohistochemistry; D015212:Inflammatory Bowel Diseases / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D013194:Staining and Labeling
D020169:Caspases
Confocal laser endomicroscopy; Epithelial extrusion zones, epithelial gaps; Inflammatory bowel disease; Irritable bowel syndrome; Small intestine