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Tropical enteropathy: a T-cell-mediated crypt hyperplastic enteropathy.

A M Veitch·P Kelly·I S Zulu·I Segal·M J Farthing
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Abstract

OBJECTIVE: Tropical enteropathy is widespread throughout the tropics, but its pathogenesis is unknown. T-cell activation has been demonstrated to result in enteropathy in vitro and in animal models, and occurs in untreated patients with coeliac disease. We have therefore examined the hypothesis that T-cell activation is important in the pathogenesis of tropical enteropathy. PATIENTS AND METHODS: Healthy black Zambian subjects were compared with black and white South Africans. Quantitative microscopy was conducted on distal duodenal biopsies. Mucosal T-cell activation was quantitated by dual colour immunofluorescence staining for CD3 plus CD69 or HLA-DR. Crypt proliferation was measured by direct counting of Feulgen-stained mitotic figures, and systemic immune activation by assay of serum tumour necrosis factor alpha (TNF-alpha). RESULTS: Villous height was reduced (P = 0.0004), crypt depth increased (P < 0.0001), and mitoses per crypt increased (P = 0.014) in black Zambians compared with black and white South Africans. Mucosal thickness was similar. Intraepithelial lymphocyte count was increased in the black groups compared with whites (P = 0.03). CD3+CD69+ (P = 0.0007) and CD3+HLA-DR+ (P < 0.0001) expression was increased in black Zambians compared with black and white South Africans. Serum TNF-alpha was similar in all groups. CONCLUSIONS: Tropical enteropathy is associated with mucosal T-cell activation and crypt hyperplasia. Tropical enteropathy occurs in the absence of malnutrition, diarrhoea or systemic illness.

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AdultAgedAntigens, CDAntigens, Differentiation, T-LymphocyteBlack PeopleCD3 ComplexFemaleFluorescent Antibody TechniqueHLA-DR AntigensHumansHyperplasiaIntestinal DiseasesIntestinal MucosaLectins, C-TypeMaleMiddle AgedSouth AfricaT-LymphocytesTropical MedicineTumor Necrosis Factor-alphaWhite PeopleZambiaCD69 AntigensJournal ArticleResearch Support, Non-U.S. Gov't

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A M Veitch, P Kelly, I S Zulu, I Segal, M J Farthing. 2001. Tropical enteropathy: a T-cell-mediated crypt hyperplastic enteropathy.. https://doi.org/10.1097/00042737-200110000-00009

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