Koichi Soga

T cell-dependent and -independent expression of intestinal epithelial cell-related molecules in rats infected with the nematode Nippostrongylus brasiliensis†

To determine how T cells of thymic origin regulate the intestinal mucous response induced by nematode infection, mucin production and goblet cell‐specific secretory peptide expression were examined in euthymic rnu/+ and athymic rnu/rnu rats infected with the nematode Nippostrongylus brasiliensis. Euthymic rats showed transient goblet cell hyperplasia and upregulation of mucin production, which returned to preinfection levels by 21 days postinfection, when nematodes had been rejected from the intestine. In athymic rats, which failed to reject nematodes, goblet cell hyperplasia and accelerated mucin production continued at least until 21 days postinfection. Gene transcription of mucin‐core peptide (MUC)‐2 and ‐3 and trefoil factor (TFF)‐2 and ‐3 in the jejunal epithelium was upregulated parallel to the levels of goblet cell hyperplasia in both euthymic and athymic rats. On the other hand, resistin‐like molecule (Relm)β, sialyltransferase Siat4c and sulfotransferase 3ST1 showed significantly higher transcription levels in euthymic than in athymic rats at 7 and/or 10 days postinfection. These results suggest that the induction of intestinal mucin production occurs without the activation of thymus‐derived T cells, while the expression of Relmβ, Siat4c and 3ST1 in the intestinal epithelial cells seems to be regulated at least partly by thymus‐dependent mechanisms.

Successful Endoscopic Injection Sclerotherapy of High-Risk Gastroesophageal Varices in a Cirrhotic Patient with Hemophilia A

A 68-year-old man with hemophilia A and liver cirrhosis caused by hepatitis C virus was referred to our hospital to receive prophylactic endoscopic treatment for gastroesophageal varices (GOV). He had large, tense, and winding esophageal varices (EV) with cherry red spots extending down to lesser curve, predicting the likelihood of bleeding. Esophageal endoscopic injection sclerotherapy (EIS) was performed with a total 15 mL of 5% ethanolamine oleate with iopamidol (EOI). Radiographic imaging during EIS demonstrated that 5% EOI reached the afferent vein of the varices. He was administered sufficient factor VIII concentrate before and after EIS to prevent massive bleeding from the varices. Seven days after EIS, upper gastrointestinal endoscopy (UGIE) showed that the varices were eradicated almost completely. Eighteen months after EIS, the varices continued to diminish. We report a successful case of safe and effective EIS for GOV in a high-risk cirrhotic patient with hemophilia A.

In vivo imaging of intestinal helminths by capsule endoscopy

This review examines the use of digestive endoscopy to visualize intestinal helminths. The infections caused by these parasites are responsible for high levels of morbidity and mortality. These helminths can be visualized using gastroduodenal endoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy. Endoscopic examination of the small bowel is limited by its considerable length and its distance from the mouth and anus. Since capsule endoscopy (CE) was first reported in 2000, it has been established as a noninvasive modality for the investigation of the gastrointestinal tract. CE is used as a first-line tool for imaging various small-bowel diseases, mainly obscure gastrointestinal bleeding and Crohns disease. Since the Food and Drug Administration (FDA) approved CE in 2001, the indications for its use have expanded widely. For example, CE can be used to visualize the in vivo kinetics of intestinal helminths. If the current trends in technological development continue, CE will become more widely used to facilitate the diagnosis and treatment of helminth infections in the near future.

Endoscopic Injection Sclerotherapy with Ethanolamine Oleate with Iopamidol for Esophagojejunal Varices in Idiopathic Portal Hypertension

Esophageal and gastric varices are the most common collateral vessels found in portal hypertension, and endoscopic therapies have been established as the treatment of choice for this condition [1]. However, standard diagnostic and therapeutic procedures have not yet been established for ectopic varices, which are rarely formed on other parts of the digestive tract [2]. Thus, although bleeding ectopic varices are regarded as potentially life-threatening [3, 4], measures to control these varices are lacking. Idiopathic portal hypertension (IPH) is the most common cause of non-cirrhotic portal hypertension in Japan [5]. IPH is a disease of unknown etiology, characterized by splenomegaly, anemia, and portal hypertension. However, liver function is usually preserved in these patients. In terms of disease pathogenesis, it has been found that IPH patients have a high incidence of portal vein (PV) thrombosis [6, 7]. Recent ultrasonography studies have revealed that about 40% of patients had PV thrombus, and angiography demonstrated an even higher rate [8, 9]. Additionally, Eguchi et al. [10] reported that portal thrombus can occur with a significantly higher incidence in patients with IPH than in those patients with cirrhosis of the liver after splenectomy. PV thrombus and subsequent obstruction worsen portal hypertension and varices. Additionally, it is well known that the varices produced by IPH are prone to recurrent rupture, because portal hypertension and its complications may progress in these patients even after successful management of variceal rupture. Therefore, control of portal hypertension and varices is important for IPH patients. Here we report on successful endoscopic injection sclerotherapy (EIS) for esophagojejunal varices in a patient with IPH and with occlusions of the PV stent and transjugular intrahepatic portosystemic shunt (TIPS).

Mucin-Related Molecular Responses of Bronchial Epithelial Cells in Rats Infected with the Nematode Nippostrongylus brasiliensis

Although mucins are essential for the protection of internal epithelial surfaces, molecular responses involving mucin production and secretion in response to various infectious agents in the airway have not been fully elucidated. The present study analysed airway goblet cell mucins in rats infected with the nematode Nippostrongylus brasiliensis, which migrates to the lungs shortly after infection. Goblet cell hyperplasia occurred in the bronchial epithelium 3–10 days after infection. The high iron diamine-alcian blue staining combined with neuraminidase treatment showed that sialomucin is the major mucin in hyperplastic goblet cells. Immunohistochemical studies demonstrated that goblet cell mucins were immunoreactive with both the major airway mucin core peptide, Muc5AC, and the major intestinal mucin core peptide Muc2. Reverse transcription real-time PCR studies demonstrated upregulation of gene transcription levels of Muc5AC, Muc2, the sialyltransferase St3gal4, and the resistin-like molecule beta (Retnlb) in the lungs. These results showed that nematode infection induces airway epithelial responses characterised by the production of sialomucin with Muc5AC and Muc2 core peptides. These mucins, as well as Retnlb, might have important roles in the protection of mucosa from migrating nematodes in the airway.