Mind the Gaps: Increased Density of Epithelial Gaps Observed in the Terminal Ileum of Patients with Inflammatory Bowel Disease Using Confocal Endomicroscopy
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Notice bibliographique
Résumé
Purpose: Epithelial cells within the small intestine undergo shedding resulting in the formation of epithelial gaps (spaces between cells). The cytokine TNF-α has been shown to accelerate this process by 20-fold. Epithelial gaps can be observed within human small and large intestine through the use of confocal endomicroscopy, and increased epithelial gap density within the duodenum has been previously reported in patients with inflammatory bowel disease (IBD). Given the role of TNF-α in the pathogenesis of IBD, we hypothesize that epithelial gap density is increased in the terminal ileum of IBD patients compared to controls. Methods: Probe-based confocal laser endomicroscopy (pCLE) is a new modality which allows in-vivo histopathologic evaluation of the intestinal mucosa. Use of the ColoFlexTM UHD miniprobe (Cellvizio, Mauna Kea Technologies, Paris, France) provides a resolution of 1.4 μm (for comparison, the diameter of a RBC is 7 μm) thus allowing visualization of epithelial cells and gaps. After intravenous injection of 5 mL of 10% fluorescein, pCLE of the terminal ileum of consecutive patients undergoing colonoscopy was performed. Controls were patients undergoing colonoscopy for non-IBD related indications; IBD patients were those with a history of biopsy-proven Crohn's disease or ulcerative colitis. We imaged endoscopically normal mucosa in the terminal ileum, as areas with visible erosions and ulcerations had significant architectural distortions making quantitative analysis of cells and gaps impossible. Over 3000 images were acquired for each patient. Gap density was defined as the number of epithelial gaps found per 1000 cells counted. Results: The experimental cohort consisted of 20 controls (9 males; mean age=51±12 years) and 15 IBD patients (9 males; mean age=39±13 years). Of the 15 IBD patients, 10 had Crohn's disease and 5 had ulcerative colitis. Endoscopically normal terminal ileal mucosa was imaged in both groups. The images were reviewed by two blinded reviewers. A minimu m of 3 confocal images with the highest epithelial gap density were analyzed for each patient; epithelial cells and gaps were manually counted. Gaps were ascertained in at least three different sequential images. The mean gap density (± SD) was 15±2 gaps per 1000 cells counted for controls versus 100 ± 8 gaps/1000 cells counted for IBD patients (p<0.0001). Conclusion: Confocal endomicroscopy revealed significantly increased epithelial gap density in endoscopically normal-appearing terminal ileum of IBD patients as compared to controls.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle