Weidinger Carl, Hegazy Ahmed N, Siegmund Britta
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie.
Berlin Institute of Health, Berlin, Germany.
Curr Opin Gastroenterol. 2018 Jul;34(4):183-186. doi: 10.1097/MOG.0000000000000445.
The occurrence of creeping fat wrapping segments of inflamed gut represents a characteristic yet incompletely understood hallmark of Crohn's disease. Over the last decade, numerous studies have provided a limited understanding of this feature. Still, deciphering the detailed mechanisms and the pathophysiologic relevance of the interplay between creeping fat, barrier function and intestinal inflammation will be the aim of future studies.
The last 18 months have substantially contributed to this field, starting with an elegant three-dimensional study revealing B cell aggregates around lymphatic vessels embedded in the mesenteric fat, thus bringing back the idea that Crohn's disease might represent a 'lymphatic disease'. Furthermore, studies on a cellular level elucidated the interplay of mesenteric adipocytes, immune cells and intestinal epithelial cells. Last, imaging studies provide evidence indicating that changes depicted by computed tomography within the mesenteric fat compartment rather than of the bowel wall are predictive for the presence of endoscopic lesions. This underlines the impact of mesenteric changes on Crohn's disease activity.
The findings of the last 18 months further contribute to solving the puzzle that will ultimately reveal the role of the mesenteric fat tissue in the control of intestinal immunity and inflammation.
炎症性肠管周围出现爬行脂肪包绕段是克罗恩病的一个特征性标志，但尚未完全被理解。在过去十年中，众多研究对这一特征的了解有限。然而，阐明爬行脂肪、屏障功能与肠道炎症之间相互作用的详细机制及其病理生理相关性将是未来研究的目标。
在过去18个月里，该领域取得了重大进展。首先是一项精妙的三维研究揭示了肠系膜脂肪中淋巴管周围的B细胞聚集，从而再次提出克罗恩病可能是一种“淋巴管疾病”的观点。此外，细胞水平的研究阐明了肠系膜脂肪细胞、免疫细胞和肠上皮细胞之间的相互作用。最后，影像学研究提供的证据表明，计算机断层扫描显示的肠系膜脂肪区域而非肠壁的变化可预测内镜下病变的存在。这突出了肠系膜变化对克罗恩病活动的影响。
过去18个月的研究结果进一步有助于解开谜团，最终揭示肠系膜脂肪组织在肠道免疫和炎症控制中的作用。
