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Related Experiment Videos

Neuroimmune appendicitis.

P Di Sebastiano1, T Fink, F F di Mola

  • 1Department of Visceral and Transplantation Surgery, University of Berne, Inselspital, Switzerland.

Lancet (London, England)
|August 28, 1999
PubMed
Summary
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Neuroproliferation involving substance P (SP) and vasoactive intestinal peptide (VIP) nerves may cause abdominal pain in non-inflamed appendices. This suggests a distinct condition called neuroimmune appendicitis.

Area of Science:

  • Gastroenterology
  • Neuroscience
  • Immunology

Background:

  • 15-25% of surgically removed appendices show no histological inflammation despite suspected appendicitis.
  • The etiology of pain in these cases remains unclear.
  • Neuropeptide alterations are observed in chronic inflammation, prompting investigation into peptidergic innervation changes.

Purpose of the Study:

  • To investigate changes in peptidergic innervation for substance P (SP), vasoactive intestinal peptide (VIP), and growth-associated protein-43 (GAP-43) in appendicitis.
  • To explore the role of neuroimmune interactions in appendiceal pain without inflammation.

Main Methods:

  • Immunocytochemistry was used to analyze SP, VIP, and GAP-43 in 31 appendix specimens (16 acute, 15 non-acute) and 16 controls.
  • Digitized morphometry assessed the density of SP immunostaining.

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  • Specimens were categorized as acute appendicitis, non-acute appendicitis, or normal.

    • Main Results:

    • Growth-associated protein-43 (GAP-43) expression was elevated in non-acute appendicitis cases.
    • Significantly higher amounts of SP- and VIP-immunoreactive nerves were found in the mucosal layer of non-acute appendices compared to controls and acute appendicitis.
    • A close spatial relationship was observed between SP/VIP nerves and lymphoid cells in the outer lymph follicle zone.

    Conclusions:

    • Increased SP and VIP neurotransmitters, along with neuroproliferation in the appendix, may contribute to right abdominal pain in the absence of acute inflammation.
    • The findings suggest 'neuroimmune appendicitis' as a distinct pathological entity.
    • This highlights the interaction between the nervous and immune systems in appendiceal pathology.