Ultrastructural features of eosinophilic oesophagitis: impact of treatment on desmosomes.
Ultrastructural features of eosinophilic oesophagitis: impact of treatment on desmosomes.
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DOI：
10.1136/jclinpath-2014-202586
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发表时间：
2015-01
影响因子：
3.4
通讯作者：
Wartchow EP
中科院分区：
文献类型：
--
作者：
Capocelli KE;Fernando SD;Menard-Katcher C;Furuta GT;Masterson JC;Wartchow EP
越来越多的证据表明上皮屏障功能的改变在嗜酸性食管炎（EoE）的病理生理中起作用，但很少有研究描述炎症期间的上皮结构。本研究的目的是确定活跃、不活跃EoE和对照组食管上皮的超微结构特征。我们前瞻性地招募了接受诊断性上内窥镜检查评估EoE的患者。从食管远端取粘膜捏活检，并进行常规组织学和电镜检查。对入选受试者的临床特征进行分析，并将受试者分为四组：正常组、胃食管反流病组（GERD）、不活跃EoE组和活跃EoE组。有代表性的显微照片的基础和浅表上皮检查异常。在基底层以上的三至四层皮刺细胞表面可见桥粒。29例儿童病例（2-18岁）被纳入研究。我们观察到，与不活跃的EoE、GERD和正常上皮相比，活跃的EoE受试者的每细胞桥粒（DPC）数量显著减少。在DPC方面，与GERD或正常受试者相比，不活跃EoE受试者之间无显著差异。观察到的其他超微结构特征包括上皮微皱和嗜酸性粒细胞迁移、脱颗粒和帽状形成的证据。与临床和分子研究结果一致，我们的超微结构数据支持小儿活动性EoE病例食管屏障改变，治疗后可能改善。
A growing body of evidence suggests a role for altered epithelial barrier function in the pathophysiology of eosinophilic oesophagitis (EoE), but few have described the epithelial structure during inflammation. The purpose of this study was to define ultrastructural features of active, inactive EoE and control subject’s oesophageal epithelia. We prospectively enrolled patients undergoing diagnostic upper endoscopy for evaluation of EoE. Mucosal pinch biopsies were obtained from the distal oesophagus and processed for routine histology and electron microscopic assessment. Clinical features of enrolled subjects were analysed and subjects were divided into four groups: normal, gastroesophageal reflux disease (GERD), inactive EoE and active EoE. Representative photomicrographs of the basal and superficial epithelia were reviewed for abnormalities. Desmosomes were quantified on the surface of epithelia three to four prickle-cell layers above the basal layer. Twenty-nine paediatric cases (ages 2–18 years) were enrolled in the study. We observed a significant decrease in the number of desmosomes per cell (DPC) of subjects with active EoE compared with inactive EoE, GERD and normal epithelia. With respect to DPC, no significant differences were found between inactive EoE compared with GERD or normal subjects. Additional ultrastructural features observed included epithelial microplicae and evidence of eosinophil transmigration, degranulation, and sombrero formation. Consistent with clinical and molecular findings, our ultrastructural data provide support for an altered oesophageal barrier in paediatric cases with active EoE, which may improve following treatment.