Kiehne Karlheinz, Brunke Gabriele, Wegner Franziska, Banasiewicz Tomas, Folsch Ulrich R, Herzig Karl-Heinz
I. Department of Internal Medicine, Universitatsklinikum Schleswig Holstein, Schittenhelmstr. 12, Kiel 24105, Germany.
World J Gastroenterol. 2006 Feb 21;12(7):1056-62. doi: 10.3748/wjg.v12.i7.1056.
Pouchitis develops in ileoanal pouches in up to 50% of patients with ulcerative colitis during the first 10 years after pouch surgery while being rare in patients after proctocolectomy for familial adenomatous polyposis coli (FAP) syndrome. Defensins are major components of the innate immune system and play a significant role in gastrointestinal microbial homeostasis. Pouch defensin and cytokine expression were correlated with states of pouch inflammation to study their role in pouchitis.
Patients with ulcerative colitis and FAP syndrome were stratified into groups with pouches after surgery, pouches without or with pouchitis. Biopsies from terminal ileum from a healthy intestine or from normal terminal ileum of patients with ulcerative colitis served as controls. mRNA from pouches and controls was analysed for defensin and cytokine expression.
Expression of defensins was increased in all pouches immediately after surgery, compared to ileum of controls. Initially, pouches in ulcerative colitis revealed higher defensin expression than FAP pouches. Defensin expression declined in both patient groups and increased again slightly in pouchitis in patients with ulcerative colitis. FAP pouches without pouchitis had strong expression of beta-defensin hBD-1, while all other defensins remained at low levels. Cytokine expression in ulcerative colitis pouches was high, while FAP pouches showed moderately elevated cytokines only after surgery.
Development of pouchitis correlates with decreased defensin expression in ulcerative colitis in addition to high expression of cytokines. The low incidence of pouchitis in FAP pouches correlates with increased expression of hBD-1 beta-defensin in association with low cytokine levels.
在回肠肛管袋状吻合术后的10年内，高达50%的溃疡性结肠炎患者会发生袋炎，而在因家族性腺瘤性息肉病（FAP）综合征接受全结肠直肠切除术后的患者中则较为罕见。防御素是先天性免疫系统的主要组成部分，在胃肠道微生物稳态中发挥重要作用。研究袋防御素和细胞因子表达与袋炎状态的相关性，以探讨它们在袋炎中的作用。
将溃疡性结肠炎和FAP综合征患者分为术后有袋、无袋或有袋炎组。取健康肠道的回肠末端活检组织或溃疡性结肠炎患者的正常回肠末端作为对照。分析袋组织和对照组织的mRNA中防御素和细胞因子的表达情况。
与对照组回肠相比，所有袋在术后立即防御素表达均增加。最初，溃疡性结肠炎患者的袋防御素表达高于FAP患者的袋。两组患者的防御素表达均下降，溃疡性结肠炎患者发生袋炎时防御素表达再次略有增加。无袋炎的FAP袋中β-防御素hBD-1表达较强，而其他所有防御素水平均较低。溃疡性结肠炎袋中的细胞因子表达较高，而FAP袋仅在术后细胞因子表达中度升高。
除细胞因子高表达外，袋炎的发生与溃疡性结肠炎中防御素表达降低有关。FAP袋中袋炎的低发病率与hBD-1β-防御素表达增加及细胞因子水平低有关。
