Morphometric study of the fibrosis and mast cell count in the circular colon musculature of chronic Chagas patients with and without megacolon

Pinheiro, Simone Wanderley; Rua, Adilha Misson de Oliveira; Etchebehere, Renata Margarida; Cançado, Cristiane G.; Chica, Javier Emílio Lazo; Lopes, Edison Reis; Adad, Sheila Jorge

doi:10.1590/s0037-86822003000400005

Cited by 27 publications

(26 citation statements)

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“…The increased amount of fibrosis found in chagasic patients could be related to the increased mastocytosis, as previously hypothesized. 47 A mild/moderate lymphocytic infiltrate, more prominent in patients with Chagas disease, was also demonstrated, mainly in the myenteric plexus. These finding are worthy of comment.…”

Section: Discussionmentioning

confidence: 91%

“…37,42 In fact, previous studies on the pathologic aspects of the neuromuscular aspects of chagasic megacolon usually only focused on one aspect, such as the enteric neurons, 1,30,48 the ICC, 22,27 the inflammatory response in the myenteric plexus, 9 and the role of mast cells and fibrosis. 47 Similar considerations may be done for idiopathic megacolon, for which such data are even scarcer. Thus, this patchy approach likely underscores the importance of integrated findings for a better understanding of the pathophysiologic mechanisms of colonic motor dysfunction in patients with megacolon.…”

Section: Discussionmentioning

confidence: 96%

“…41 Previous studies on chagasic colonic involvement have described degeneration and decreased number of intrinsic myenteric neurons, 1,30 reduced number of nitric oxidecontaining myenteric neurons, 48 deficiency of interstitial cells of Cajal (ICC), 22,27 ganglion cell damage by T lymphocytes, 9 and increased fibrosis and mast cell count. 47 However, almost all such data were obtained in Brazilian patients as single studies on a specific aspect, and a comprehensive assessment of the enteric nervous system in the colon of chagasic patients from other countries has no previously been reported.…”

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confidence: 99%

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The Enteric Nervous System in Chagasic and Idiopathic Megacolon

Iantorno

Bassotti

Kogan³

et al. 2007

American Journal of Surgical Pathology

139

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Chagas disease frequently causes megacolon. We investigated the enteric nervous systems in patients with chagasic megacolon compared to idiopathic megacolon and controls. Surgical specimens were obtained from 12 patients with chagasic megacolon (1 woman, 11 men, age range 41 to 72 y) and 9 patients with idiopathic megacolon (3 women, 6 men, age range 39 to 68 y), undergoing surgery for intractable constipation. A control group of 10 patients (9 women, 1 man, age range 43 to 75 y) undergoing left hemicolectomy for nonobstructing colorectal cancer was also studied. Colonic sections were investigated by conventional and immunohistochemical methods, also taking into consideration the presence of lymphocytes. Compared to controls, the 2 megacolon groups showed a decrease of enteric neurons (not due to increased apoptosis) and of enteric glial cells (all more important in chagasic patients). The interstitial cells of Cajal subtypes were decreased but not absent in megacolons, although an increase of the intramuscular subtype was found, suggesting a possible compensative mechanism. An increased amount of fibrosis was found in the smooth muscle and the myenteric plexus of chagasic patients compared to the idiopathic megacolon and the control group. A mild lymphocytic infiltration of the enteric plexuses (more evident in Chagas disease) was also found in megacolons but not in controls. Patients with chagasic megacolon display important abnormalities of several components of the enteric nervous system. Similar alterations, although of lesser severity, may be found in patients with idiopathic megacolon.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

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The Enteric Nervous System in Chagasic and Idiopathic Megacolon

Iantorno

Bassotti

Kogan³

et al. 2007

American Journal of Surgical Pathology

139

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“…5) have been reported for chagasic patients (219,363). In the digestive tube, inflammatory lesions result in the depopulation of parasympathetic neurons (314). The pathological lesions found in chronic chagasic patients classify the disease accordingly to the affected organ in the body.…”

Section: Clinical and Pathological Presentations Of Chagas' Diseasementioning

confidence: 99%

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

et al. 2011

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SUMMARY Acute Trypanosoma cruzi infections can be asymptomatic, but chronically infected individuals can die of Chagas' disease. The transfer of the parasite mitochondrial kinetoplast DNA (kDNA) minicircle to the genome of chagasic patients can explain the pathogenesis of the disease; in cases of Chagas' disease with evident cardiomyopathy, the kDNA minicircles integrate mainly into retrotransposons at several chromosomes, but the minicircles are also detected in coding regions of genes that regulate cell growth, differentiation, and immune responses. An accurate evaluation of the role played by the genotype alterations in the autoimmune rejection of self-tissues in Chagas' disease is achieved with the cross-kingdom chicken model system, which is refractory to T. cruzi infections. The inoculation of T. cruzi into embryonated eggs prior to incubation generates parasite-free chicks, which retain the kDNA minicircle sequence mainly in the macrochromosome coding genes. Crossbreeding transfers the kDNA mutations to the chicken progeny. The kDNA-mutated chickens develop severe cardiomyopathy in adult life and die of heart failure. The phenotyping of the lesions revealed that cytotoxic CD45, CD8 + γδ, and CD8α + T lymphocytes carry out the rejection of the chicken heart. These results suggest that the inflammatory cardiomyopathy of Chagas' disease is a genetically driven autoimmune disease.

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“…In CD, human collagen deposition has been demonstrated in various organs, such as the heart (Palomino et al 2000;Rossi 2001;López et al 2006), pancreas (Saldanha et al 2001), spleen (Pereira et al 2002), esophagus (Cabral 2000), colon (Pinheiro et al 2003), and tongue (de Lima Pereira et al 2006). When the collagen densities in the myocardium and tongue were analyzed together, the chagasic patient group showed a significant increase in collagen density when compared with the nonchagasic patient group, which is consistent with other studies in patients with chronic CD who were shown to have more collagen in the organs infected with T. cruzi (Coura and Borges-Pereira 2010).…”

Section: Discussionmentioning

confidence: 99%

Comparison between the collagen intensity and mast cell density in the lingual muscles and myocardium of autopsied chronic chagasic and nonchagasic patients

et al. 2012

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In chronic Chagas' disease (CD), an increase in collagen intensity and mast cell density has been described individually in the myocardium and tongue muscles. The aim of this study was to compare the percentage of collagen, mast cell tryptase (MCT) density, and mast cell chymase (MCH) density in the lingual muscles and myocardium from autopsied chagasic (CP) and nonchagasic patients (NCP). The selected cases were divided into two groups: (1) CP (n = 10) and (2) NCP (n = 10). Fragments were removed from the tongue and heart. After histological processing, the slices were stained with picrosirius, and immunohistochemistry was performed for MCH and MCT. The CP group showed the highest MCH and MCT densities and the highest percentage of collagen in the lingual muscles and myocardium when compared with the NCP group (p < 0.05). A significant positive correlation was observed between the collagen intensity and MCH density in the myocardium of the CP group. Although there are no reports in the literature of MCT and MCH in CD, its higher densities as well as higher percentage of collagen were found in the lingual muscles and myocardium in the CP group, suggesting that tryptase and chymase are associated with the pathogenesis of CD in these organs. Furthermore, the positive and significant correlation between the percentage of collagen and MCH density in the myocardium of the CP group suggests that the chymase is associated with fibrosis in CD, as demonstrated in other diseases.

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Morphometric study of the fibrosis and mast cell count in the circular colon musculature of chronic Chagas patients with and without megacolon

Cited by 27 publications

References 5 publications

The Enteric Nervous System in Chagasic and Idiopathic Megacolon

The Enteric Nervous System in Chagasic and Idiopathic Megacolon

Pathogenesis of Chagas' Disease: Parasite Persistence and Autoimmunity

Comparison between the collagen intensity and mast cell density in the lingual muscles and myocardium of autopsied chronic chagasic and nonchagasic patients

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