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Digestive Diseases and Sciences
Erschienen in:

07.08.2024 | Original Article

Absence of Paneth Cell Metaplasia to Predict Clinical Relapse in Ulcerative Colitis with Endoscopically Quiescent Mucosa

verfasst von: Kazuki Horiuchi, Masaaki Higashiyama, Hiroyuki Tahara, Yuta Yoshidome, Kana Ayaki, Hiroyuki Nishimura, Akira Tomioka, Kazuyuki Narimatsu, Shunsuke Komoto, Kengo Tomita, Ryota Hokari

Erschienen in: Digestive Diseases and Sciences | Ausgabe 10/2024

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Abstract

Background

Paneth cells play multiple roles in maintaining intestinal homeostasis. However, the clinical role of Paneth cell metaplasia (PCM) in ulcerative colitis (UC) remains unclear. We aimed to investigate the relationship between PCM and relapse in patients with UC and compare the usefulness of PCM with other histological indexes, including mucin depletion (MD) and basal plasmacytosis (BP).

Methods

Patients with UC in clinical remission (CR) who underwent colonoscopy to confirm a Mayo endoscopic subscore (MES) ≦1 with biopsies from the distal colon were enrolled into this retrospective cohort study. Biopsy samples were evaluated for histological findings of PCM, MD, and BP. Clinical relapse was defined as partial Mayo score ≧3 or medication escalation. Multivariate analysis was performed to determine independent predictors of relapse among the three histological findings, MES, and patient background, and relapse prediction models were generated.

Results

Eighty-three patients were enrolled in this study (MES 0, n = 47; MES 1, n = 36). The number of PCM cases was significantly higher in patients with prolonged CR than that in those with relapse (p = 0.01). Multivariate analysis showed that the absence of PCM and MD were related to relapse in all the patients. In patients with MES 1, the absence of PCM was the only risk factor significantly and independently associated with relapse (hazard ratio, 4.51 [1.15–17.7]; p = 0.03).

Conclusion

The absence of PCM was a histological risk factor for relapse in patients with MES 1, implying a protective role for PCM in remission and a new index for mucosal healing.
Literatur
1.
Barreto EBL, Rattes IC, da Costa AV et al. Paneth cells and their multiple functions. Cell Biol Int. 2022;46:701–710.CrossRef
2.
Tanaka M, Saito H, Kusumi T et al. Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease. J Gastroenterol Hepatol. 2001;16:1353–1359.CrossRefPubMed
3.
Kővári B, Báthori Á, Friedman MS et al. Histologic diagnosis of inflammatory bowel diseases. Adv Anat Pathol. 2022;29:48–61.CrossRefPubMed
4.
Wehkamp J, Harder J, Weichenthal M et al. NOD2 (CARD15) mutations in Crohn’s disease are associated with diminished mucosal alpha-defensin expression. Gut. 2004;53:1658–1664.CrossRefPubMedPubMedCentral
5.
Günther C, Martini E, Wittkopf N et al. Caspase-8 regulates TNF-α-induced epithelial necroptosis and terminal ileitis. Nature. 2011;477:335–339.CrossRefPubMedPubMedCentral
6.
Frøslie KF, Jahnsen J, Moum BA et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology. 2007;133:412–422.CrossRefPubMed
7.
Reinisch W, Van Assche G, Befrits R et al. Recommendations for the treatment of ulcerative colitis with infliximab: a gastroenterology expert group consensus. J Crohns Colitis. 2012;6:248–258.CrossRefPubMed
8.
Travis SP, Higgins PD, Orchard T, Panaccione R, Bitton A et al. Review article: defining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011;34:113–124.CrossRefPubMed
9.
Reinink AR, Lee TC, Higgins PD. Endoscopic mucosal healing predicts favorable clinical outcomes in inflammatory bowel disease: a meta-analysis. Inflamm Bowel Dis. 2016;22:1859–1869.CrossRefPubMed
10.
Bressler B, Marshall JK, Bernstein CN et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology. 2015;148:1035–58.e3.CrossRefPubMed
11.
Peyrin-Biroulet L, Bressenot A, Kampman W. Histologic remission: the ultimate therapeutic goal in ulcerative colitis? Clin Gastroenterol Hepatol. 2014;12:929–34.e2.CrossRefPubMed
12.
Boal Carvalho P, Cotter J. Mucosal healing in ulcerative colitis: a comprehensive review. Drugs. 2017;77:159–173.CrossRefPubMed
13.
Dal Buono A, Roda G, Argollo M et al. Histological healing: should it be considered as a new outcome for ulcerative colitis? Expert Opin Biol Ther. 2020;20:407–412.CrossRef
14.
Ma C, Sedano R, Almradi A et al. An international consensus to standardize integration of histopathology in ulcerative colitis clinical trials. Gastroenterology. 2021;160:2291–2302.CrossRefPubMed
15.
Andreas S, Christian M, Emma C et al. ECCO-ESGAR guideline for diagnostic assessment in IBD part 2: IBD scores and general principles and technical aspects. J Crohns Colitis. 2019;13:273–284.CrossRef
16.
Neeraj N, Achuthan A, Abdul-Aziz A et al. Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission. Aliment Pharmacol Ther. 2020;52:1676–1682.CrossRef
17.
Triana L, Talat B, Alexandra R et al. Prognostic value of histological activity in patients with ulcerative colitis in deep remission: a prospective multicenter study. United European Gastroenterol J. 2018;6:765–772.CrossRef
18.
Park S, Abdi T, Gentry M et al. Histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol. 2016;111:1692–1701.CrossRefPubMed
19.
Narula N, Aruljothy A, Alshahrani AA et al. Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission. Aliment Pharmacol Ther. 2020;52:1676–1682.CrossRefPubMed
20.
Nenci A, Becker C, Wullaert A et al. Epithelial NEMO links innate immunity to chronic intestinal inflammation. Nature. 2007;446:557–561.CrossRefPubMed
21.
Ozaki R, Kobayashi T, Okabayashi S et al. Histological risk factors to predict clinical relapse in ulcerative colitis with endoscopically normal mucosa. J Crohns Colitis. 2018;12:1288–1294.CrossRefPubMed
22.
23.
Bitton A, Peppercorn MA, Antonioli DA et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology. 2001;120:13–20.CrossRefPubMed
24.
Bryant RV, Burger DC, Delo J et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2016;65:408–414.CrossRefPubMed
25.
Simmonds N, Furman M, Karanika E et al. Paneth cell metaplasia in newly diagnosed inflammatory bowel disease in children. BMC Gastroenterol. 2014;14:93.CrossRefPubMedPubMedCentral
26.
27.
Magro F, Langner C, Driessen A et al. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–851.CrossRefPubMed
28.
Barreiro-de Acosta M, Vallejo N, de la Iglesia D et al. Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study. J Crohns Colitis. 2016;10:13–19.CrossRefPubMed
29.
Nakamura K, Sakuragi N, Takakuwa A et al. Paneth cell α-defensins and enteric microbiota in health and disease. Biosci Microbiota Food Health. 2016;35:57–67.CrossRefPubMed
30.
Sato T, van Es JH, Snippert HJ et al. Paneth cells constitute the niche for Lgr5 stem cells in intestinal crypts. Nature. 2011;469:415–418.CrossRefPubMed
31.
Jauregui-Amezaga A, López-Cerón M, Aceituno M et al. Accuracy of advanced endoscopy and fecal calprotectin for prediction of relapse in ulcerative colitis: a prospective study. Inflamm Bowel Dis. 2014;20:1187–1193.CrossRefPubMed
32.
Christensen B, Hanauer SB, Erlich J et al. Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol Hepatol. 2017;15:1557–64.e1.CrossRefPubMedPubMedCentral
33.
Bessissow T, Lemmens B, Ferrante M et al. Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol. 2012;107:1684–1692.CrossRefPubMed
34.
Tanaka M, Riddell RH, Saito H et al. Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn’s disease from ulcerative colitis. Scand J Gastroenterol. 1999;34:55–67.CrossRefPubMed
35.
36.
Gui X, Li J, Ueno A et al. Histopathological features of inflammatory bowel disease are associated with different CD4+ T cell subsets in colonic mucosal lamina propria. J Crohns Colitis. 2018;12:1448–1458.PubMed
Metadaten
Titel
Absence of Paneth Cell Metaplasia to Predict Clinical Relapse in Ulcerative Colitis with Endoscopically Quiescent Mucosa
verfasst von
Kazuki Horiuchi
Masaaki Higashiyama
Hiroyuki Tahara
Yuta Yoshidome
Kana Ayaki
Hiroyuki Nishimura
Akira Tomioka
Kazuyuki Narimatsu
Shunsuke Komoto
Kengo Tomita
Ryota Hokari
Publikationsdatum
07.08.2024
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 10/2024
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-024-08581-9

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