Paneth cell metaplasia in newly diagnosed inflammatory bowel disease in children

Abstract

BackgroundPaneth cell metaplasia (PCM) is well described in adults but little is known about the distribution of colonic Paneth cells and the occurrence of PCM in a paediatric population. The aim of this study is to determine whether Paneth cell hyperplasia or metaplasia characteristically occurs in the colons of children with newly diagnosed idiopathic inflammatory bowel disease (IBD).MethodsWe retrospectively reviewed colonic series from 28 new diagnoses of paediatric IBD at a tertiary referral centre, and from a further 14 children with IBD-like symptoms whose colonic biopsies and ancillary investigations were normal. Paneth cells were counted at 6 anatomical sites in the colon, and at each site acute and chronic inflammation were assessed semi-quantitatively and the presence or absence of crypt architectural distortion and eosinophilia was documented.ResultsIn control, ulcerative colitis (UC) and Crohn’s disease (CD) groups there was a gradient of decreasing Paneth cell numbers from caecum to rectum. Paneth cells were not seen in the distal colon in the control group, but they were present there in 11 of 13 patients with ulcerative colitis and 14 of 15 with Crohn’s disease. Only patients with IBD showed Paneth cell hyperplasia, assessed as more than 10 Paneth cells per 10 well-oriented crypts at any site. There was a statistically significant increase in Paneth cells in the caecum, ascending, transverse and descending colon in UC and in the ascending, transverse, descending and sigmoid colon in CD compared with controls. There was no significant difference between UC and CD. There was no correlation between the site of PCM and acute or chronic inflammation, crypt distortion or eosinophilia.ConclusionPaneth cells are found in the proximal but not the distal colon in otherwise normal paediatric colonic series. A high proportion of UC and CD patients show PCM in the distal colon. This is present early in the disease and does not correlate with histological features of chronicity.

Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis

“…Our findings expand the understanding of the presence of Paneth cell metaplasia. A small, single-center study by Simmonds and colleagues found that Paneth cell metaplasia was found in the distal colon in 85% of children with IBD (UC and Crohn’s disease) while it was absent in age-matched healthy controls (17). In contrast, we found Paneth cell metaplasia to be uncommon, identified in only 8% of rectal biopsies.…”

Relationship Between Oligosaccharides and Glycoconjugates Content in Human Milk and the Development of the Gut Barrier

“…Paneth cells are abundant in the small intestine and can be found in the proximal but not distal colon (Simmonds, Furman, Karanika, Phillips, & Bates, 2014). Their function is to secrete antimicrobial components, such as lysozymes, defensin α (HD5-HD6), and β (hBD-1, -2, -3), phospholipase A2, angiogenin 4, and cathelicidins (Gassler, 2017).…”

How are the expression patterns of gut antimicrobial peptides modulated by human gastrointestinal diseases? A bridge between infectious, inflammatory, and malignant diseases

“…Under physiological conditions, Paneth cells are found only in the small intestine, where they provide support and protection to resident stem cells and play an important role in the innate immune response by producing unique AMPs . However, Paneth cells are also found in the colonic, gastric, or oesophageal mucosa (colorectal, gastric, or oesophageal metaplasia) from patients with chronic GI inflammatory diseases, including ulcerative colitis, Crohn's disease, Barrett's oesophagus, and gastric intestinal metaplasia (Table ) . This Paneth cell metaplasia may represent a protective mechanism triggered upon increased demands for antimicrobial defenses, suggesting infections to play an etiologic role in such conditions.…”