title: Characterization of smooth muscle, enteric nerve, interstitial cells of Cajal, and fibroblast-like cells in the gastric musculature of patients with diabetes mellitus.
abstract: OBJECTIVE
  To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus (DM).
  
  
  METHODS
  Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson's Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5 (PGP9.5), neuronal nitric oxide synthase (nNOS), vasoactive intestinal peptide (VIP), neurokinin-1 (NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha, (PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.
  
  
  RESULTS
  Twenty-six controls and 35 diabetic patients (21 short-duration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index (BMI) (higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group (P< 0.01). On immunohistochemical staining, c-Kit- and PDGFRα-positive immunoreactivity were significantly decreased in the DM group compared with the control group (P< 0.05). There were no statistically significant differences in PGP9.5, nNOS, VIP, and neurokinin 1 expression. On immunofluorescent staining, cellularity of interstitial cells of Cajal (ICC) was observed to decrease with increasing duration of DM.
  
  
  CONCLUSIONS
  Our study suggests that increased intercellular fibrosis, loss of ICC, and loss of fibroblast-like cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Park
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Il Seon
authors.initials: IS
authors.lastname: Hwang
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Kyeong Ok
authors.initials: KO
authors.lastname: Kim
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Jeon
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Park
authors.affiliation: Kyung Sik Park, Kwang Bum Cho, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
authors.forename: Joong Goo
authors.initials: JG
authors.lastname: Kwon
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000473:pathology; D017615:Enteric Nervous System / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique; D005753:Gastric Mucosa / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009130:Muscle, Smooth / Q000378:metabolism* / Q000473:pathology; D052248:Nitric Oxide Synthase Type I / Q000378:metabolism; D019009:Proto-Oncogene Proteins c-kit / Q000378:metabolism; D020796:Receptor, Platelet-Derived Growth Factor alpha / Q000378:metabolism; D018040:Receptors, Neurokinin-1 / Q000378:metabolism; D013270:Stomach / Q000473:pathology; D000067170:Telocytes / Q000378:metabolism* / Q000473:pathology; D013997:Time Factors; D043222:Ubiquitin Thiolesterase / Q000378:metabolism; D014660:Vasoactive Intestinal Peptide / Q000378:metabolism
chemical_list: D018040:Receptors, Neurokinin-1; C482860:UCHL1 protein, human; D014660:Vasoactive Intestinal Peptide; C496320:NOS1 protein, human; D052248:Nitric Oxide Synthase Type I; D019009:Proto-Oncogene Proteins c-kit; D020796:Receptor, Platelet-Derived Growth Factor alpha; D043222:Ubiquitin Thiolesterase
keywords: Diabetes mellitus; Enteric nerve system; Fibroblast-like cell; Gastroparesis; Interstitial cells of Cajal