Cellular and Molecular Gastroenterology and Hepatology (Jan 2021)

Lack of Mucosal Cholinergic Innervation Is Associated With Increased Risk of Enterocolitis in Hirschsprung’s DiseaseSummary

  • Simone Keck,
  • Virginie Galati-Fournier,
  • Urs Kym,
  • Michèle Moesch,
  • Jakob Usemann,
  • Isabelle Müller,
  • Ulrike Subotic,
  • Sasha J. Tharakan,
  • Thomas Krebs,
  • Eleuthere Stathopoulos,
  • Peter Schmittenbecher,
  • Dietmar Cholewa,
  • Philipp Romero,
  • Bertram Reingruber,
  • Elisabeth Bruder,
  • NIG Study Group,
  • Stefan Holland-Cunz

Journal volume & issue
Vol. 12, no. 2
pp. 507 – 545

Abstract

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Background & Aims: Hirschsprung’s disease (HSCR) is a congenital intestinal motility disorder defined by the absence of enteric neuronal cells (ganglia) in the distal gut. The development of HSCR-associated enterocolitis remains a life-threatening complication. Absence of enteric ganglia implicates innervation of acetylcholine-secreting (cholinergic) nerve fibers. Cholinergic signals have been reported to control excessive inflammation, but the impact on HSCR-associated enterocolitis is unknown. Methods: We enrolled 44 HSCR patients in a prospective multicenter study and grouped them according to their degree of colonic mucosal acetylcholinesterase-positive innervation into low-fiber and high-fiber patient groups. The fiber phenotype was correlated with the tissue cytokine profile as well as immune cell frequencies using Luminex analysis and fluorescence-activated cell sorting analysis of colonic tissue and immune cells. Using confocal immunofluorescence microscopy, macrophages were identified in close proximity to nerve fibers and characterized by RNA-seq analysis. Microbial dysbiosis was analyzed in colonic tissue using 16S-rDNA gene sequencing. Finally, the fiber phenotype was correlated with postoperative enterocolitis manifestation. Results: The presence of mucosal nerve fiber innervation correlated with reduced T-helper 17 cytokines and cell frequencies. In high-fiber tissue, macrophages co-localized with nerve fibers and expressed significantly less interleukin 23 than macrophages from low-fiber tissue. HSCR patients lacking mucosal nerve fibers showed microbial dysbiosis and had a higher incidence of postoperative enterocolitis. Conclusions: The mucosal fiber phenotype might serve as a prognostic marker for enterocolitis development in HSCR patients and may offer an approach to personalized patient care and new therapeutic options.

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