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AIM:Pouchitis develops in ileoanal pouches in up to50% of patients with ulcerative colitis during the first 10years after pouch surgery while being rare in patientsafter proctocolectomy for familial adenomatous polyposiscoil(FAP)syndrome.Defensins are major components ofthe innate immune system and play a significant role ingastrointestinal microbial homeostasis.Pouch defensinand cytokine expression were correlated with states ofpouch inflammation to study their role in pouchitis.METHODS:Patients with ulcerative colitis and FAPsyndrome were stratified into groups with pouches aftersurgery,pouches without or with pouchitis.Biopsies fromterminal ileum from a healthy intestine or from normalterminal ileum of patients with ulcerative colitis served ascontrols,mRNA from pouches and controls was analysedfor defensin and cytokine expression.RESULTS:Expression of defensins was increased in allpouches immediately after surgery,compared to ileumof controls.Initially,pouches in ulcerative colitis revealedhigher defensin expression than FAP pouches.Defensinexpression declined in both patient groups and increasedagain slightly in pouchitis in patients with ulcerativecolitis.FAP pouches without pouchitis had strongexpression of β-defensin hBD-1,while all other defensinsremained at low levels.Cytokine expression in ulcerativecolitis pouches was high,while FAP pouches showedmoderately elevated cytokines only after surgery.CONCLUSION:Development of pouchitis correlates with decreased defensin expression in ulcerative colitisin addition to high expression of cytokines.The lowincidence of pouchitis in FAP pouches correlates withincreased expression of hBD-1 β-defensin in associationwith low cytokine levels.
AIM: Pouchitis develops in ileoanal pouches in up to 50% of patients with ulcerative colitis during the first 10years after pouch surgery while being rare in patients after proctocolectomy for familial adenomatous polyposiscoil (FAP) syndrome. Defensins are major components of the innate immune system and play a significant role ingastrointestinal microbial homeostasis. Pouch defensin and cytokine expression were associated with states of touch inflammation to study their role in pouchitis. METHODS: Patients with ulcerative colitis and FAPsyndrome were stratified into groups with pouches aftersurgery, pouches without or with pouchitis. Biopsies fromterminal ileum from a healthy intestine or from normalterminal ileum of patients with ulcerative colitis served as controls, mRNA from pouches and controls was was segregated for defensin and cytokine expression .RESULTS: Expression of defensins was increased in allpouches immediately after surgery, compared to ileum of controls. Inially, pouches in ulcerative colitis revealedhigher defensin expression than FAP pouches.Defensine expression suppressed in both patient groups and increasedagain slightly in pouchitis in patients with ulcerativecolitis. FAP pouches without pouchitis had strongexpression of β-defensin hBD-1, while all other defensins were ma at at low levels. Cytokine expression in ulcerative colitis pouches was high, while FAP pouches showedmoderately elevated cytokines only after surgery. CONCLUSION: Development of pouchitis correlates with decreased defensin expression in ulcerative colitisin addition to high expression of cytokines. The lowincidence of pouchitis in FAP pouches correlates withincreased expression of hBD-1 β-defensin in association with low cytokine levels.