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Crohn's Disease Recurrence After Ileocolonic Resection: Higher BDNF Levels in Healthy Ileum Is Associated to a Longer Recurrence-Free Interval
Imerio Angriman*1, Andromachi Kotsafti2, Melania Scarpa2, Giovanni Tagliente1, Giovanni Bordignon1, Renata D'Inca3, Romeo Bardini1, Carlo Castoro4, Claudia Mescoli5, Massimo Rugge5, Mario Gruppo1, Ignazio Castagliuolo2, Marco Scarpa4
1Surgery, University of Padova, Vicenza, Italy; 2Molecular Medicine, University of Padova, Padova, Italy; 3Surgical, Oncological & Gastroenterological, University of Padova, Padova, Italy; 4Surgery, Veneto Istitute of Oncology, Padova, Italy; 5Dept of Medicine, University of Padova, Padova, Italy
Introduction. In Crohn's disease (CD) patients both the quantity and function of the myenteric neurons are altered by intestinal inflammation. Brain-derived neurotrophic factor (BDNF) is a neurotrophin present in the intestine where it participates in survival and growth of enteric neurons. Surgical treatment is required in about 70% of CD patients during the course of disease, but recurrence occurs in at least 35-40% often because of fibrotic stenosis of previous anastomosis.
Aim of the study. The aim of the study is to understand if quantity and function of the myenteric neurons may be related to bowel fibrosis or to a short recurrence interval after CD surgery.
Pazienti e metodi. Thirty-five consecutive CD patients who underwent ileo-colonic resection were enrolled. Mucosal samples were obtained from both healthy and inflamed ileum. Clinical records with pre- and post-operative details were retrieved. Fibrosis grade was evaluated with a pathological score and presence of hyperplasia/hypertrophia of myenteric neurons and ganglia was assessed. Concentrations of BDNF, was determined with immunometric assay. Clinical postoperative recurrence was defined as HBI >8 (moderate-to-severe activity). Comparisons and correlations were carried out with non-parametric tests.
Results. Expression of BDNF was significantly higher in inflamed than in healthy ileum in CD patients (p<0,01). During the 29 months of follow-up, moderate-to-severe clinical POR occurred in 20% of patients (7/35). Concentration of BDNF in CD patients’ healthy ileum directly correlated with the length of recurrence-free interval (r=0,598; p=0,038). On the contrary, in patients with hyperplasia/hypertrophia of myenteric neurons and ganglia the recurrence-free interval tended to be shorter (p=0,089).
Conclusions. Higher concentration of BDNF in CD patients’ healthy ileum is associated to a longer recurrence-free interval while hyperplasia/hypertrophia of myenteric neurons and ganglia is associated to a shorter one.
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