Gastrointestinal mast cells in health and disease. Part II

Accumulation of Mast Cells in the Lesions and Effects of Antiallergic Drugs on the Patients with Inflammatory Bowel Disease

The pathomechanism of inflammatory bowel disease (IBD) has not yet been fully demonstrated. However, it is well known that mast cells are present in the gastrointestinal tract, suggesting that mast cells may take part in it. So, we investigated the number of mast cells in IBD, such as ulcerative colitis (UC) and eosinophilic colitis, and showed that the number of mast cells was increased in the inflammatory lesions. We also presented a case of UC which was treated successfully with an antiallergic drug, tranilast. Furthermore, possible new approaches to treating the disease with immunomodulators including suplatast are introduced. However, our investigations were performed with a limited number of patients with IBD, and additional further studies are required to confirm the findings.

Pathogenesis, classification and treatment of mastocytosis: state of the art in 2010 and future perspectives

Mastocytosis is a myeloid neoplasm characterized by abnormal accumulation and frequent activation of mast cells (MCs) in various organs. Organ systems typically involved are the bone marrow, skin, liver and gastrointestinal tract. In most adult patients, the systemic form of mastocytosis (SM) is diagnosed, which includes an indolent subvariant, an aggressive subvariant and a leukemic subvariant, also termed MC leukemia. Whereas in pediatric mastocytosis, which is usually confined to the skin, a number of different KIT mutations and other defects may be detected, the KIT mutation D816V is detectable in most (adult) patients with SM. In a subset of these patients, additional oncogenic factors may lead to enhanced survival and growth of MCs and, thus, to advanced SM. Other factors may lead to MC activation, with consecutive anaphylactic reactions that can be severe or even fatal. Treatment of SM usually focuses on symptom relief by histamine receptor antagonists and other supportive therapy. However, in aggressive and leukemic variants, cytoreductive and targeted drugs must be applied. Unfortunately, the prognosis in these patients remains poor, even when treated with novel KIT-targeting agents, polychemotherapy or stem cell transplantation. This article provides a summary of our knowledge on the pathogenesis and on treatment options in SM.

Accumulation of mast cells in the interstitium of eosinophilic colitis

INTRODUCTION

The mechanism of eosinophilic colitis remains unclear, and no case has been reported in which the number of mast cells was examined.

CASE REPORT

A 35-year-old man presented to our hospital with chief complaints of chills and consistent watery diarrhea after eating raw fresh-water fish. In blood examination, peripheral blood eosinophilia was found. Histological examination from biopsy specimens of both the ascending colon and rectum showed a prominent eosinophilic infiltration in the intestinal mucosa. Although a provocation test could not be performed due to lack of informed consent, a diagnosis of eosinophilic colitis was made on the basis of other findings. Immunohistochemical staining for human mast cell tryptase using monoclonal antibody against human mast cell tryptase showed an accumulation of mast cells in the colonic interstitium.

CONCLUSIONS

We report a case of eosinophilic colitis in which an accumulation of mast cells in the colonic interstitium was demonstrated.

Necrotizing enterocolitis, pathogenesis and the protector effect of prenatal corticosteroids

Necrotizing enterocolitis is the most frequently occurring gastrointestinal disorder in premature neonates. Animal models of necrotizing enterocolitis and prenatal administration of cortisone have demonstrated that cortisone may accelerate maturation of the mucosal barrier, therefore reducing the incidence of this gastrointestinal disorder. The authors present a review of the literature of the most important risk factors associated with necrotizing enterocolitis, such as inflammatory gastrointestinal mediators, enteral feeding and bacterial colonization, and immaturity of the gastrointestinal barrier, and we emphasize the necessity for additional studies to explore the prenatal administration of cortisone as a preventive strategy for necrotizing enterocolitis.

Platelet-activating factor and interleukin 1 are involved in colonic dysmotility in experimental colitis in rats

BACKGROUND

Intracolonic administration of trinitrobenzene sulfonic acid (TNBS) to rats produces chronic colitis associated with an increased release of eicosanoids, platelet-activating factor (PAF), and interleukins.

METHODS

Motor effects of TNBS on proximal colon were evaluated electromyographically in rats. Mediator involvement was investigated using eicosanoids and PAF antagonists.

RESULTS

The colonic myoelectrical activity was 59 +/- 17 spike bursts per hour lasting 6.9 +/- 1.3 seconds. Two to eight days after TNBS treatment, spike-burst duration was significantly (P < 0.05) higher, with a maximal 1.5-4-fold enhancement at day 3. These alterations were significantly (P < 0.05) reduced by daily treatment with MK-886, a 5-lipoxygenase inhibitor (10 mg/kg, orally), whereas indomethacin (1 mg/kg per day, intramuscularly) was ineffective. At day 3, RP55778, a PAF antagonist (45, 60 mg/kg, intraperitoneally), and rIRAP, an interleukin 1 antagonist (0.3 mg/kg, intraperitoneally) but not KT1-32, a thromboxane A2 antagonist (30, 60 mg/kg orally), nor SKF104,353, a leukotriene D4 antagonist (2, 4 mg/kg, orally), significantly (P < 0.05) reduced the TNB-induced motor effects.

CONCLUSION

TNBS-induced colitis in rats involves a delayed long-lasting dysmotility involving PAF, interleukin 1, and some leukotrienes but not leukotriene D4, thromboxane A2, or other cyclo-oxygenase products.

Leukotriene D4 participates in colonic transit disturbances induced by intracolonic administration of trinitrobenzene sulfonic acid in rats

The effects of colonic inflammation induced by trinitrobenzene sulfonic acid and influence of previous treatment with specific antagonists of inflammatory mediators (platelet-activating factor, leukotrienes, prostaglandins, and thromboxanes) on colonic transit were examined in conscious rats which were permanently fitted with an intracolonic catheter inserted into the proximal colon. Colonic inflammation was induced by intracolonic administration of trinitrobenzene acid (80 mg/kg) in 50% ethanol. Colonic transit time was evaluated by intracolonic administration of a radiolabeled marker [( 51Cr]sodium chromate) and collection of the feces per hour on a conveyor belt. Excretion of the marker was then plotted vs. time, permitting calculations of the times elapsed to recover 25%, 50%, and 75% of the marker injected (T25, T50, and T75, respectively). In control (saline) animals, excretion of the marker described a regular sigmoid curve with 50% of the marker recovered at 6.92 +/- 0.40 hours after intracolonic administration (T25 = 6.4 +/- 0.43 hours; T75 = 7.49 +/- 0.39 hours). Ethanol (vehicle), 50%, did not modify the profile of marker recovery. On the contrary, single intracolonic administration of trinitrobenzene sulfonic acid/ethanol induced a biphasic response consisting of an early pool of radiolabeled feces (T25 = 4.03 +/- 0.55 hours) with a delayed total one (T50 = 11.74 +/- 0.83 hours; T75 = 13.70 +/- 0.49 hours). Antagonists of the leukotriene pathway, i.e., MK = 886, a lipoxygenase inhibitor, and SKF 104,353 and SR 2640, two different leukotriene D4 receptor antagonists, blocked the effects of trinitrobenzene sulfonic acid on colonic transit time and restored a control profile of radiolabeled marker excretion. In contrast, indomethacin, a cyclooxygenase inhibitor, and SC 19220, a specific prostaglandin E2 receptor antagonist, were inefficient in blocking the effects of trinitrobenzene sulfonic acid on colonic transit time. Specific thromboxane A2 receptor antagonists, KT1-32 and GR 32191B, did not show any improvement in colonic transit after trinitrobenzene sulfonic acid administration. Previous injection of the specific platelet-activating factor receptor antagonists, BN 52021 or BN 50730, was also unable to restore a normal marker excretion profile after administration of trinitrobenzene sulfonic acid. It is concluded that the alterations of colonic transit immediately observed after intracolonic trinitrobenzene sulfonic acid administration are mediated through the release of leukotriene D4. In contrast, platelet-activating factor, prostaglandins, and thromboxanes are not involved in the mediation of these transit disturbances.

Role of platelet-activating factor in ulcerative colitis. Enhanced production during active disease and inhibition by sulfasalazine and prednisolone

Platelet-activating factor is released from inflammatory cells. It activates neutrophils, releases secondary messengers, and mediates mucosal ulceration and ischemia in the rat. We assessed its possible role in the pathogenesis of ulcerative colitis. Colonic biopsy specimens from patients with active ulcerative colitis and controls were incubated for 4 h in Tyrode's buffer in the presence or absence of 0.2 microM calcium ionophore (A23187) or 50 microliter of antihuman immunoglobulin E. Platelet-activating factor was determined in the tissue by aggregation assay after extraction with 80% ethanol and was confirmed by thin-layer chromatography and its inactivation by phospholipases. Platelet-activating factor was not detected in normal mucosa. Only A23187 and antihuman immunoglobulin E stimulated its activity: mean +/- SE, 43.2 +/- 8.6 and 33.0 +/- 6.1 pg/10 mg wet wt, respectively. In active ulcerative colitis basal platelet-activating factor activity was 8.9 +/- 3.5 pg/10 mg wet wt. A23187 and antihuman immunoglobulin E induced significantly higher stimulation of platelet-activating factor synthesis when compared with their effects on normal mucosa: 200 +/- 28 and 70 +/- 8.3 pg/10 mg wet wt, respectively. The enhanced stimulation induced by A23187 was dose-dependently inhibited by salazopyrine, 5-amino-salicylic acid, and prednisolone, but not by sulfapyridine. It is thus suggested that platelet-activating factor may be involved in the pathogenesis of the inflammatory response in ulcerative colitis and that its inhibition by steroids, 5-aminosalicylic acid, and salazopyrine may be an additional mechanism to explain their therapeutic effects.

The anatomical basis for the immune function of the gut

The barrier function of the gut wall can be divided into different histotopographically defined lines of defence. These consist not only of lymphoid cells but also of goblet cells, entero-endocrine cells, macrophages and mast cells. Subsets of lymphoid cells are found preferentially within the epithelium (T suppressor) or in the lamina propria (T helper). Most plasma cells produce IgA. Peyer's patches are described in detail as typical organized lymphoid structures of the gut. In man, they are present well before birth and are found in large numbers even in old age. They are not only typical for the ileum but are also present in the duodenum and jejunum. The four compartments in Peyer's patches, i.e. follicle, corona, interfollicular area and the dome, are defined by the typical localization of lymphocyte subsets and by their different functions. Typical features of the epithelium of the dome are the lack of villi and goblet cells and the presence of specialized epithelial cells (M cells) which are important for the uptake of particulate antigen from the gut lumen. Precursor cells of IgA producing plasma cells leave the intestinal wall via the lymphatics and return preferentially to the gut mucosa, and this is summarized by the term gut-associated lymphoid tissue (GALT). Other organs with mucous membranes, such as mammary and salivary glands, bronchial and genital tract, are also included in this circulatory route and this is expressed by the term mucosa-associated lymphoid tissue (MALT). Mast cells in the gut mucosa can be classified as connective tissue or mucosa mast cells. These differ in their sensitivity to formaldehyde as a fixative, contain different granules and mediators, have different origins, and show major differences in the effectiveness of antiallergic compounds on the stabilizing of the cell membrane. Mucosa mast cells have also been demonstrated in the human gut. The histotopographical relationship of many cell types such as goblet and M cells in addition to cells of the immune system such as lymphoid cells, macrophages and mast cells, is essential in the understanding of the barrier function of the gut wall.

Human mast cells detected by monoclonal antibodies

We report the establishment of seven mouse-mouse hybridoma cell lines secreting monoclonal antibodies with specificity for granule components of all human mast cells. Reactivity is directed against a molecule which is also found intracytoplasmically in human mature small intestinal enterocytes, liver parenchymal cells, and kidney proximal tubule epithelial cells. No reactivity of these antibodies was found with any other human or animal cell type examined. In particular, the antibodies did not react with basophils or other haemopoietic cell types. This study shows the potential of specific monoclonal antibodies as a tool for identifying and enumerating infiltrating mast cells in tissues. Such antibodies should be of value in investigations into the role of the mast cell in immunological reactions and hypersensitivity diseases.