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Th17 cells reflect colon submucosal pathologic changes in active eosinophilic granulomatosis with polyangiitis.

Tsurikisawa N, Oshikata C, Tsuburai T, Sugano S, Nakamura Y, Shimoda T, Tamama S, Adachi K, Horita A, Saito I, Saito H - BMC Immunol. (2015)

Bottom Line: Th17 cells (%) and serum ICAM-1 levels at onset were greater in EGPA than in CEP.Eosinophilia and colonic submucosal edematous change were greater in EGPA than in CEP.The mechanism of vasculitis in EGPA appears related to increases in serum Th17 cell numbers and ICAM-1 levels and decreases in VEGF levels.

View Article: PubMed Central - PubMed

Affiliation: Departments of Allergy and Respirology, Sagamihara, Kanagawa, Japan. n-tsurikisawa@sagamihara-hosp.gr.jp.

ABSTRACT

Background: Chronic eosinophilic pneumonia (CEP) or eosinophilic gastroenteritis (EG), or both, with asthma precede the onset of eosinophilic granulomatosis with polyangiitis (EGPA) in half of all EGPA patients. It is not known what determines whether patients with CEP or with EG following asthma will develop EGPA.

Methods: We studied 17 EGPA patients and 12 patients with CEP but without EGPA. We assayed serum ICAM-1, VCAM-1, and VEGF, and the percentage of peripheral blood CD4(+) T cells producing IL-17 (Th17 cells), at both onset and remission. We also examined the numbers of submucosal eosinophils and the basement membrane-to-crypt and crypt-to-crypt distance to evaluate edema in the colon submucosa at onset and remission in EGPA and at onset in CEP.

Results: Nine of 12 (75.0%) CEP patients had symptoms or endoscopic findings. Colonic submucosal eosinophil counts and edema in EGPA at onset were greater than at remission or in CEP at onset. Th17 cells (%) and serum ICAM-1 levels at onset were greater in EGPA than in CEP. In EGPA, peripheral blood Th17 cells (%) were significantly correlated with serum ICAM-1 level, colonic submucosal eosinophil count, and degree of edematous change; inversely correlated with serum VEGF level; but not correlated with VCAM-1 level.

Conclusions: Eosinophilia and colonic submucosal edematous change were greater in EGPA than in CEP. The mechanism of vasculitis in EGPA appears related to increases in serum Th17 cell numbers and ICAM-1 levels and decreases in VEGF levels.

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Related in: MedlinePlus

Endoscopic findings in the large intestine in patients with eosinophilic granulomatosis with polyangiitis (EGPA) (a–c) or chronic eosinophilic pneumonia (CEP) (d–f). Arrows show ulcer (A), erosion (B), dark red sign (C), and various red flares (D, E, F). The number in bright green indicated a region biopsied. EGPA patients had subjective symptoms related to the endoscopic findings in the lower digestive organs (e.g. abdominal pain, diarrhea, and blood in the stool), but there were no subjective symptoms in patients with CEP
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Fig1: Endoscopic findings in the large intestine in patients with eosinophilic granulomatosis with polyangiitis (EGPA) (a–c) or chronic eosinophilic pneumonia (CEP) (d–f). Arrows show ulcer (A), erosion (B), dark red sign (C), and various red flares (D, E, F). The number in bright green indicated a region biopsied. EGPA patients had subjective symptoms related to the endoscopic findings in the lower digestive organs (e.g. abdominal pain, diarrhea, and blood in the stool), but there were no subjective symptoms in patients with CEP

Mentions: The incidence of clinical symptoms related to both the upper and lower abdomen did not differ between the two groups (Table 1). There were various findings in the colonic mucosa (Fig. 1) as well as the gastro-duodenum mucosa (data not shown) in EGPA patients (ulceration, erosion, or dark red signs). In contrast, there were only slight changes in the colonic mucosa, such as red flare, in patients with CEP (and Fig. 1). However, the overall incidence of positive colonic mucosal findings on endoscopy did not differ between the two groups. In contrast, positive gastroscopic findings were more common in EGPA patients than those in CEP patients (P < 0.05, Table 1).Fig. 1


Th17 cells reflect colon submucosal pathologic changes in active eosinophilic granulomatosis with polyangiitis.

Tsurikisawa N, Oshikata C, Tsuburai T, Sugano S, Nakamura Y, Shimoda T, Tamama S, Adachi K, Horita A, Saito I, Saito H - BMC Immunol. (2015)

Endoscopic findings in the large intestine in patients with eosinophilic granulomatosis with polyangiitis (EGPA) (a–c) or chronic eosinophilic pneumonia (CEP) (d–f). Arrows show ulcer (A), erosion (B), dark red sign (C), and various red flares (D, E, F). The number in bright green indicated a region biopsied. EGPA patients had subjective symptoms related to the endoscopic findings in the lower digestive organs (e.g. abdominal pain, diarrhea, and blood in the stool), but there were no subjective symptoms in patients with CEP
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696253&req=5

Fig1: Endoscopic findings in the large intestine in patients with eosinophilic granulomatosis with polyangiitis (EGPA) (a–c) or chronic eosinophilic pneumonia (CEP) (d–f). Arrows show ulcer (A), erosion (B), dark red sign (C), and various red flares (D, E, F). The number in bright green indicated a region biopsied. EGPA patients had subjective symptoms related to the endoscopic findings in the lower digestive organs (e.g. abdominal pain, diarrhea, and blood in the stool), but there were no subjective symptoms in patients with CEP
Mentions: The incidence of clinical symptoms related to both the upper and lower abdomen did not differ between the two groups (Table 1). There were various findings in the colonic mucosa (Fig. 1) as well as the gastro-duodenum mucosa (data not shown) in EGPA patients (ulceration, erosion, or dark red signs). In contrast, there were only slight changes in the colonic mucosa, such as red flare, in patients with CEP (and Fig. 1). However, the overall incidence of positive colonic mucosal findings on endoscopy did not differ between the two groups. In contrast, positive gastroscopic findings were more common in EGPA patients than those in CEP patients (P < 0.05, Table 1).Fig. 1

Bottom Line: Th17 cells (%) and serum ICAM-1 levels at onset were greater in EGPA than in CEP.Eosinophilia and colonic submucosal edematous change were greater in EGPA than in CEP.The mechanism of vasculitis in EGPA appears related to increases in serum Th17 cell numbers and ICAM-1 levels and decreases in VEGF levels.

View Article: PubMed Central - PubMed

Affiliation: Departments of Allergy and Respirology, Sagamihara, Kanagawa, Japan. n-tsurikisawa@sagamihara-hosp.gr.jp.

ABSTRACT

Background: Chronic eosinophilic pneumonia (CEP) or eosinophilic gastroenteritis (EG), or both, with asthma precede the onset of eosinophilic granulomatosis with polyangiitis (EGPA) in half of all EGPA patients. It is not known what determines whether patients with CEP or with EG following asthma will develop EGPA.

Methods: We studied 17 EGPA patients and 12 patients with CEP but without EGPA. We assayed serum ICAM-1, VCAM-1, and VEGF, and the percentage of peripheral blood CD4(+) T cells producing IL-17 (Th17 cells), at both onset and remission. We also examined the numbers of submucosal eosinophils and the basement membrane-to-crypt and crypt-to-crypt distance to evaluate edema in the colon submucosa at onset and remission in EGPA and at onset in CEP.

Results: Nine of 12 (75.0%) CEP patients had symptoms or endoscopic findings. Colonic submucosal eosinophil counts and edema in EGPA at onset were greater than at remission or in CEP at onset. Th17 cells (%) and serum ICAM-1 levels at onset were greater in EGPA than in CEP. In EGPA, peripheral blood Th17 cells (%) were significantly correlated with serum ICAM-1 level, colonic submucosal eosinophil count, and degree of edematous change; inversely correlated with serum VEGF level; but not correlated with VCAM-1 level.

Conclusions: Eosinophilia and colonic submucosal edematous change were greater in EGPA than in CEP. The mechanism of vasculitis in EGPA appears related to increases in serum Th17 cell numbers and ICAM-1 levels and decreases in VEGF levels.

Show MeSH
Related in: MedlinePlus