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Published on: August 7, 2017
Mucosal Mast Cell Distribution in the Gastrointestinal Tract of Children: A Preliminary Study for Establishing
Christoph Ehrsam1,2, Tobias Rechenauer1, Ida Allabauer1
1Pediatric Gastroenterology and Hepatology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg.
Insights
Pediatric gastrointestinal mast cell (MC) counts are higher than previously thought, with significant differences observed in children with gastrointestinal food allergies (GFA). These findings establish new reference values for MC distribution in the pediatric gut.
Area of Science:
- Gastroenterology
- Immunology
- Pediatric Pathology
Background:
- Mast cells (MCs) play a role in gastrointestinal disorders, but their normal physiological numbers and distribution in the pediatric population are not well-established.
- Lack of defined reference values hinders accurate diagnosis of conditions like gastrointestinal food allergies (GFA).
Purpose of the Study:
- To systematically investigate the distribution and number of mast cells (MCs) throughout the pediatric gastrointestinal (GI) tract.
- To establish physiological reference values and identify disease-defining cut-offs for MCs in healthy children and those with GFA.
Main Methods:
- Histological examination of biopsies from the esophagus to the rectum in a control cohort of nine healthy pediatric subjects.
- Investigation of fifteen pediatric patients with suspected GFA.
- Immunohistochemistry using CD117 (c-Kit) to quantify MCs in the lamina propria.
Main Results:
- Distinct differences in MC counts were observed across all segments of the pediatric GI tract.
- The highest MC counts were found in the duodenum, terminal ileum, cecum, and ascending colon in both groups.
- Significant disparities in MC counts between GFA patients and healthy subjects were noted in the gastric corpus and ascending colon.
Conclusions:
- Pediatric mucosal MC counts in the GI tract are higher than previously reported, with considerable overlap between healthy and GFA patients.
- This study provides the first estimates of physiological MC values in childhood, detailing their distribution and numbers.
- Further laboratory parameters need integration for improved diagnostic procedures in GFA.
Objectives:
The physiological number and distribution of mast cells (MCs) in the pediatric gastrointestinal (GI) tract is not well defined and reference values of normality are missing. To define a physiological and disease defining cut-off, a systematic histological exploration of MC distribution from the esophagus to the rectum in healthy as well as in patients with gastrointestinal food allergies (GFA) was performed.
Methods:
Nine pediatric subjects that exhibited unremarkable histopathological evaluations or underwent endoscopy for surveillance reasons after a previous polypectomy of single colonic juvenile polyps served as reference cohort. In all of these subjects, a chronic inflammatory disease (eg, inflammatory bowel disease, celiac disease) or allergy was excluded. In addition, a group of 15 patients with gastrointestinal complaints suspected to be caused by a GFA were investigated. Immunohistochemistry was performed from all biopsies using CD117 (c-Kit) as a reliable marker to identify MCs in the lamina propria.
Results:
There were distinct differences of MC counts in all parts of the pediatric GI tract. The highest counts of MCs in both symptomatic patients and control cohort, were found in the duodenum, terminal ileum, cecum and ascending colon. The lowest counts were found in the esophagus. Significant disparities between GFA and healthy subjects were found in the gastric corpus (22.1 ± 4.0/ high power field [HPF] vs 32.0 ± 10.1/HPF; P = 0.034) and ascending colon (44.8 ± 10.4/HPF vs 60.4 ± 24.3/HPF; P = 0.047).
Conclusions:
Mucosal MC counts in the pediatric GI tract are higher than previously reported, with a considerable overlap between healthy and GFA patients. These results provide detailed information on distribution and numbers of MCs in pediatric allergic patients while allowing estimates of physiological values in childhood for the first time. With regard to diagnostic procedures in GFA further laboratory parameters have to be integrated.
