The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

Marjanne den Braber-Ymker, Martin Lammens, Michel J.A.M. van Putten, Iris D. Nagtegaal

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Abstract

Neurogenic bowel dysfunction occurs in a large percentage of adult patients with spina bifida (SB) and spinal cord injury (SCI), significantly affecting their quality of life. Although bowel motility is autonomously regulated by the enteric nervous system (ENS), disruption of the modulation of the ENS by extrinsic innervation as present in many patients with SB and SCI might lead to motility disorders. In order to gain insight in the pathophysiology, we studied histological changes of the neuromuscular structures in the colon of SB and SCI patients. Archival colon tissue blocks from SB (n = 13) and SCI (n = 34) patients were collected nationwide in The Netherlands and compared with control samples (n = 16). Histological (semiquantitative) evaluation of the ENS, the network of interstitial cells of Cajal (ICC), and the muscularis propria was performed using hematoxylin and eosin, periodic acid Schiff, and elastic von Gieson staining, and immunohistochemistry with antibodies against HuC/D, calretinin, S100, CD117, α-smooth muscle actin, and desmin. Compared to controls, SB and SCI patients showed neuronal loss and decreased nerve fiber density in the myenteric plexus. Lower nerve fiber density was significantly more often found in patients with severe bowel dysfunction. Other major findings were loss of ICCs around the myenteric plexus and fibrosis in the longitudinal muscle layer. Altered histology of the ENS may explain abnormal intestinal motility in SB and SCI patients. Furthermore, loss of myenteric nerve fibers (including enteric glial cells) may play a major role in the development of severe motility complaints.

Original languageEnglish
Pages (from-to)175-184
Number of pages10
JournalVirchows Archiv
Volume470
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

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Enteric Nervous System
Spinal Dysraphism
Spinal Cord Injuries
Colon
Nerve Fibers
Myenteric Plexus
Neurogenic Bowel
Interstitial Cells of Cajal
Calbindin 2
Periodic Acid
Gastrointestinal Motility
Desmin
Hematoxylin
Eosine Yellowish-(YS)
Neuroglia
Netherlands
Smooth Muscle
Actins
Histology
Fibrosis

Keywords

  • Colon
  • Immunohistochemistry
  • Intestinal motility
  • Neuromuscular disease
  • Spina bifida
  • Spinal cord injury

Cite this

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title = "The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury",
abstract = "Neurogenic bowel dysfunction occurs in a large percentage of adult patients with spina bifida (SB) and spinal cord injury (SCI), significantly affecting their quality of life. Although bowel motility is autonomously regulated by the enteric nervous system (ENS), disruption of the modulation of the ENS by extrinsic innervation as present in many patients with SB and SCI might lead to motility disorders. In order to gain insight in the pathophysiology, we studied histological changes of the neuromuscular structures in the colon of SB and SCI patients. Archival colon tissue blocks from SB (n = 13) and SCI (n = 34) patients were collected nationwide in The Netherlands and compared with control samples (n = 16). Histological (semiquantitative) evaluation of the ENS, the network of interstitial cells of Cajal (ICC), and the muscularis propria was performed using hematoxylin and eosin, periodic acid Schiff, and elastic von Gieson staining, and immunohistochemistry with antibodies against HuC/D, calretinin, S100, CD117, α-smooth muscle actin, and desmin. Compared to controls, SB and SCI patients showed neuronal loss and decreased nerve fiber density in the myenteric plexus. Lower nerve fiber density was significantly more often found in patients with severe bowel dysfunction. Other major findings were loss of ICCs around the myenteric plexus and fibrosis in the longitudinal muscle layer. Altered histology of the ENS may explain abnormal intestinal motility in SB and SCI patients. Furthermore, loss of myenteric nerve fibers (including enteric glial cells) may play a major role in the development of severe motility complaints.",
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The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury. / den Braber-Ymker, Marjanne; Lammens, Martin; van Putten, Michel J.A.M.; Nagtegaal, Iris D.

In: Virchows Archiv, Vol. 470, No. 2, 01.02.2017, p. 175-184.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

AU - den Braber-Ymker, Marjanne

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AU - van Putten, Michel J.A.M.

AU - Nagtegaal, Iris D.

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AB - Neurogenic bowel dysfunction occurs in a large percentage of adult patients with spina bifida (SB) and spinal cord injury (SCI), significantly affecting their quality of life. Although bowel motility is autonomously regulated by the enteric nervous system (ENS), disruption of the modulation of the ENS by extrinsic innervation as present in many patients with SB and SCI might lead to motility disorders. In order to gain insight in the pathophysiology, we studied histological changes of the neuromuscular structures in the colon of SB and SCI patients. Archival colon tissue blocks from SB (n = 13) and SCI (n = 34) patients were collected nationwide in The Netherlands and compared with control samples (n = 16). Histological (semiquantitative) evaluation of the ENS, the network of interstitial cells of Cajal (ICC), and the muscularis propria was performed using hematoxylin and eosin, periodic acid Schiff, and elastic von Gieson staining, and immunohistochemistry with antibodies against HuC/D, calretinin, S100, CD117, α-smooth muscle actin, and desmin. Compared to controls, SB and SCI patients showed neuronal loss and decreased nerve fiber density in the myenteric plexus. Lower nerve fiber density was significantly more often found in patients with severe bowel dysfunction. Other major findings were loss of ICCs around the myenteric plexus and fibrosis in the longitudinal muscle layer. Altered histology of the ENS may explain abnormal intestinal motility in SB and SCI patients. Furthermore, loss of myenteric nerve fibers (including enteric glial cells) may play a major role in the development of severe motility complaints.

KW - Colon

KW - Immunohistochemistry

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