Introduction
It is important to make a differential diagnosis between inflammatory diseases of the bowel with similar clinical and endoscopic features. Misdiagnosis or delayed diagnosis can affect patients' therapeutic outcomes and prognosis. The profiling of immune cells is helpful for accurately diagnosing inflammatory diseases. Futhermore, evaluating differences of immune marker expression between Crohn’s disease (CD), intestinal Behcet’s disease (BD), and intestinal tuberculosis (TB) could be useful in differentiating the diseases.
Aims & Methods
This study aimed to compare the expression levels of immune markers between CD, intestinal BD, and intestinal TB and evaluate the usefulness of immune profiling in differential diagnoses using this advanced imaging system. Biopsy specimens were acquired around ulcerations on the terminal ileum or cecum from five patients with each disease. Panel 1 included multiplexed immunohistochemistry staining for CD8, CD4, Foxp3, CD20, programmed death-1, and granzyme B. CD56, CD68, CD163, CD11c, and HLA-DR were analyzed in panel 2. Cell density was used to compare the expression levels of immune cells.
Results
The expression of immune cells in panel 1 was not different between diseases. Differences in cytotoxic T cells, helper T cells, and regulatory T cells identified by the double-positivity method were also not significant. However, the expression of CD68+ cells in panel 2 was the highest in intestinal BD among bowel diseases (Table 1). In the co-expression method, the expression levels of M1 macrophages (CD56-CD68+CD163-HLA-DR-) and dendritic cells (CD56-CD68-CD163-CD11c+HLA-DR+) were significantly different (P = 0.001, P = 0.012, respectively).
Table 1. Comparison of immune cell densities in panel 2 between Crohn’s disease, intestinal Behcet’s disease, and intestinal tuberculosis
| Crohn’s disease
| Intestinal Behcet's disease
| Intestinal tuberculosis
| p-value
|
CD56+, median cells/mm2 (range)
| 199 (63-263)
| 75 (44-335)
| 160 (14-602)
| 0.582
|
CD68+, median cells/mm2 (range)
| 530 (508-840)
| 1828 (1648-3366)
| 1224 (508-1404)
| <0.001
|
CD163+, median cells/mm2 (range)
| 63 (17-228)
| 154 (89-408)
| 114 (69-167)
| 0.165
|
CD11c+, median cells/mm2 (range)
| 362 (20-1160)
| 19 (0-616)
| 304 (36-649)
| 0.252
|
HLA-DR+, median cells/mm2 (range)
| 258 (193-451)
| 152 (3-640)
| 890 (168-1147)
| 0.208
|
Conclusion
The expression of immune cells, including M1 macrophages and dendritic cells, was different between CD, intestinal BD, and intestinal TB. Immune profiling can be helpful for differential diagnoses of inflammatory bowel diseases.
References
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