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Updated: Jan 8, 2026
Mouse- and Human-derived Primary Gastric Epithelial Monolayer Culture for the Study of Regeneration
Published on: May 7, 2018
New insights in metaplasia in autoimmune gastritis
Tatiana S Driva1, Stratigoula Sakellariou1, Irene Theochari1
11st Department of Pathology, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Aims:
Metaplastic alterations of oxyntic mucosa in autoimmune gastritis (AIG) remain under investigation. This study aimed to characterize pyloric gland-like and intestinal metaplasia (IM) in AIG and assess their origin and prognostic significance.
Methods:
A retrospective analysis of 147 H. pylori-negative AIG gastric biopsies was conducted. Twenty cases underwent immunohistochemical staining for MUC5AC, MUC6 and TFF2, and double immunostaining for MUC6-CDX2, MUC5AC-CDX2 and TFF2-CDX2.
Results:
Corpus mucosa showed pyloric gland-like metaplasia in 98.6% (145/147) and IM in 81.6% (120/147) of cases; IM was complete in 99.2% (119/120). Epithelial dysplasia was absent; one signet-ring cell carcinoma was identified. Most cases were OLGA stage II (92.5%) and OLGIM stage I (58.5%). Metaplastic pyloric-like glands expressed MUC6, the mucin of normal antral glands, but also MUC5AC, the mucin of gastric pits and surface epithelium, a combination congruent with a distinct metaplastic subtype. All cases exhibited biphenotypic gastric mucous cells co-expressing MUC5AC-CDX2 (median 4.8% of MUC5AC-positive cells) and MUC6-CDX2 (median 3.1% of MUC6-positive cells) in glands and surface/foveolar epithelium. Glands with a mixed cellular population showing mucinous, biphenotypic, intestinal and intermediate 'transition' features provided further evidence of intestinal trans-differentiation. TFF2 was present in 25% (5 cases), in few glandular cells without CDX2 co-expression.
Conclusions:
Oxyntic mucosa metaplasia in AIG constitutes a complex phenomenon of successive phases of cellular plasticity characterized by the appearance of a distinct pyloric-like metaplastic subtype followed by intestinal trans-differentiation. The autoimmune metaplastic background appears non-carcinogenic regarding intestinal-type adenocarcinoma development.
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