Diagnostic and Clinical Course of Small Colon Recurrent Impaction Associated with Severe Myenteric Ganglionopathy in A Mare

A 10-year-old Koninklijk Warmbloed Paardenstamboek Nederland (KWPN, Netherlands-based organization for registration of the Dutch Warmblood horses) mare was evaluated three times over four months because of recurrent colic. At every referral, a physical examination revealed a small colon impaction, which partially responded to food deprivation and oral administration of water and magnesium sulphate. Due to the recurrent nature of the small colon impaction, several differential diagnoses were considered: inflammatory bowel disease (IBD), chronic salmonellosis and myenteric ganglionopathies. At first admission, an exploratory laparotomy was proposed, but the owner declined. On the second hospitalisation, the mare underwent a standing exploratory laparoscopy, but no abnormality related to the small colon was detected and resolved with a soap-based enema. At the third hospitalisation, the owner agreed to the exploratory laparotomy, which allowed surgical biopsies of the caecum and the large and small colon. Lymphomonocytic enteritis and mild myenteric ganglionitis were diagnosed. After laparotomy, the mare regularly fed and defecated, but a few days later, tachycardia, fever and abundant gastric reflux occurred. As the clinical condition rapidly deteriorated, the owner elected for euthanasia. A post-mortem histological examination showed severe chronic lymphocytic enterocolitis and typhlitis associated with the marked depletion of myenteric ganglion bodies. Small colon impaction is a very common disorder of the small colon in horses. In the presence of myenteric ganglionopathies, this case proposes the controversial matter of primary or secondary disorders of enteric neuromuscular function as the base of repeated small colon impactions of the horse. In this mare, recurrent small colon impaction was considered secondary to severe myenteric ganglionopathy associated with chronic intestinal pseudo-obstruction.

Myenteric networks of interstitial cells of Cajal are reduced in horses with inflammatory bowel disease

BACKGROUND

Inflammatory bowel disease (IBD) is a well-recognised but poorly understood disease complex in the horse. Clinical signs may vary but often include weight loss, diarrhoea and colic. The effect this disease process may have on the gastrointestinal pacemaker cells (the interstitial cells of Cajal), enteric neurons and glial cells has not been previously evaluated in the horse.

OBJECTIVES

To compare the density of the interstitial cells of Cajal (ICC), enteric neurons and glial cells in horses with IBD to those of normal horses using immunohistochemical markers.

STUDY DESIGN

Retrospective, quantitative immunohistochemical study.

METHODS

Ileal samples were collected during post-mortem examinations from 14 horses with a clinical and histopathological diagnosis of IBD and from eight normal controls. All horses were Standardbreds 1-15 years of age. Six of the IBD cases had eosinophilic gastroenteritis (EG) while the remaining eight had granulomatous enteritis (GE). Tissue sections were labelled with anti-CD117 (c-Kit), anti-TMEM16 (TMEM16), anti-protein gene product (PGP9.5) and anti-glial fibrillary acidic protein (GFAP) using standard immunohistochemical labelling techniques. Image analysis was performed to quantify the presence of ICC (CD117, TMEM16) as well as neuronal (PGP9.5) and enteroglial (GFAP) networks.

RESULTS

Interstitial cells of Cajal networks were significantly reduced in the myenteric plexus (MP) region in IBD horses compared with the controls for both markers (P<0.05). There was no significant difference in the density of the neuronal or glial cell markers between the two groups (P>0.05).

MAIN LIMITATIONS

The number of horses included in the study.

CONCLUSIONS

Disruption to ICC networks may contribute to the clinical signs of colic in some horses with IBD. Further studies are needed to establish the pathophysiological mechanisms involved and the functional effects of the reduced ICC networks.

A study of residual lesions in horses that recovered from clinical signs of chronic equine dysautonomia

BACKGROUND

Equine dysautonomia (ED) causes degeneration and loss of autonomic neurons. Approximately 50% of chronic cases recover, but it is unclear how they survive neuronal loss.

OBJECTIVES

To assess lesions, autonomic neuron numbers, interstitial cells of Cajal (ICC), and neurodegeneration in recovered cases.

ANIMALS

Thirteen cases (group ED), euthanized 10.3 ± 5.2 (1-16) years from diagnosis and 6 age-matched controls (group C).

METHODS

Prospective, case control; routine post mortem examination, neuron counts in peripheral and enteric ganglia and immunohistochemical assessment of neural networks (Protein gene product [PGP] 9.5), ICC (c-kit), and neurodegeneration (beta-amyloid precursor protein and ubiquitin) in intestine.

RESULTS

Postmortem findings in group ED were small intestinal dilation (4/12, 33%) and muscular hypertrophy (4/12, 33%), and gastric mucosal hypertrophy (3/11, 27%) and ulceration (4/11, 36%). Neuron density was lower in group ED (mean 39% lower for cranial cervical ganglion [P < .001], median 44% lower in celiacomesenteric ganglion [P = .01]). In intestine, neuronal depletion was worst in ileum (median 100% lower in submucosal plexus [P < .001], 91% lower in myenteric plexus [P = .004]). Group ED had less PGP 9.5 staining in ileal myenteric plexus (mean 66% lower [P = .04]) and circular muscle (median 75% lower [P = .006]). In ileum, there was less c-kit staining in myenteric plexus (median 57% lower [P = .02]) but not muscularis externa. Beta-amyloid precursor protein and ubiquitin results were not indicitive of neurodegeneration.

CONCLUSIONS AND CLINICAL IMPORTANCE

Intact ICC in muscularis externa might help maintain motility after neuronal loss. Treatment supporting ICC function warrants investigation.

Proteinase-activated receptor 2 expression in the intestinal tract of the horse

Proteinase-activated receptor 2 (PAR2) is a G-protein-coupled receptor for trypsin and mast cell tryptase; it is highly expressed at the intestinal level with multiple functions, such as epithelial permeability and intestinal motility. Many proteases activate PAR2 during tissue damage, suggesting a role of the inflammatory response receptors. The aim of the study was to evaluate the distribution and expression of PAR2 in the jejunum, the ileum and the pelvic flexure, using samples collected from healthy adult horses after slaughter. Proteinase-activated receptor 2 immunoreactivity (PAR2-IR) was observed in the enterocytes, intestinal glands, the smooth muscle of the muscularis mucosae, and the longitudinal and circular muscle layers; there were no differences in the distribution of PAR2-IR in the different sections of the intestinal tract. The protein expression level showed that the relative amount of the PAR2 content in the mucosa of the intestinal tract decreased from the small to the large intestine while the PAR2 mRNA analysed showed similar values. This study provides relevant findings concerning the distribution of the PAR2 in the intestines of healthy horses and represents the starting point for evaluating the role of the PAR2 during strangulative intestinal disease and consequent systemic intestinal reperfusion/injury complications in horses in order to identify and employ antagonist PAR2 molecules.

Expression of β2 adrenoceptors within enteric neurons of the horse ileum

The activity of the gastrointestinal tract is regulated through the activation of adrenergic receptors (ARs). Since data concerning the distribution of ARs in the horse intestine is virtually absent, we investigated the distribution of β2-AR in the horse ileum using double-immunofluorescence. The β2-AR-immunoreactivity (IR) was observed in most (95%) neurons located in submucosal plexus (SMP) and in few (8%) neurons of the myenteric plexus (MP). Tyrosine hydroxylase (TH)-IR fibers were observed close to neurons expressing β2-AR-IR. Since β2-AR is virtually expressed in most neurons located in the horse SMP and in a lower percentage of neurons in the MP, it is reasonable to retain that this adrenergic receptor could regulate the activity of both secretomotor neurons and motor neurons innervating muscle layers and blood vessels. The high density of TH-IR fibers near β2-AR-IR enteric neurons indicates that the excitability of these cells could be directly modulated by the sympathetic system.

The interstitial cells of Cajal of the equine gastrointestinal tract: what we know so far

Gastrointestinal motility disorders are a serious problem in both veterinary and human medicine and may represent a dysfunction of the neural, muscular or pacemaker components (interstitial cells of Cajal) of bowel control. The interstitial cells of Cajal are considered to be the pacemakers and mediators of certain forms of neurotransmission in the gastrointestinal tract. These cells have been implicated, either primarily or secondarily, in the pathogenesis of gastrointestinal disease processes in which there is a prominent element of disturbance to intestinal motility. In the horse, their involvement has been implicated in large intestinal obstructive colic and grass sickness (equine dysautonomia). This review highlights the properties of the interstitial cells of Cajal and the role these cells play in orchestrating gastrointestinal motility patterns. In addition, it examines their role in intestinal motility disorders and summarises our current understanding of their importance in the equine gastrointestinal tract.