Differential Cathelicidin Expression in Duodenal and Gastric Biopsies from Tanzanian and German Patients

Epithelial surfaces such as the gastrointestinal mucosa depend on expression of antimicrobial peptides like cathelicidin for immune defence against pathogens. The mechanisms behind mucosal cathelicidin regulation are incompletely understood. Cathelicidin expression was analysed in duodenal, antral and corpus/fundic mucosal biopsies from African and German patients. Additionally, cathelicidin expression was correlated with Helicobacter pylori (HP) infection and the inflammatory status of the mucosa. High cathelicidin transcript abundance was detected in duodenal biopsies from African subjects. On the contrary, cathelicidin mRNA expression was either undetectable or very low in tissue specimens from German patients. Also, in the antrum and corpus/fundus regions of the stomach significantly higher cathelicidin transcript levels were measured in Tanzanian compared to German patients. In gastric biopsies from African patients cathelicidin expression was increased in HP positive compared to HP negative subjects. Additionally, the inflammatory status measured by IL-8 expression correlated well with the HP infection status. A higher duodenal and gastric cathelicidin expression in African (compared with European) individuals may be due to upregulation by antigenic stimulation and may confer a higher resistance against enteric infections

A Fibreoptic Endoscopic Study of Upper Gastrointestinal Bleeding at Bugando Medical Centre in Northwestern Tanzania: a Retrospective Review of 240 Cases.

Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P < 0.001). Rebleeding was reported in 3.3% of the patients. The overall mortality rate of 11.7% was significantly higher in patients with variceal bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with higher Rockall scores and those who underwent surgery (P < 0.001). Oesophageal varices are the commonest cause of upper gastrointestinal bleeding in our environment and it is associated with high morbidity and mortality. The diagnostic accuracy of fibreoptic endoscopy was related to the time interval between the onset of bleeding and endoscopy. Therefore, it is recommended that early endoscopy should be performed within 24 h of the onset of bleeding

Expression of cathelicidin mRNA in biopsies from the stomach.

<p>(A) Biopsies from the antrum of 10 German and 27 African patients were analyzed by real-time PCR for cathelicidin mRNA expression. (B) Biopsies from the corpus and fundus of 15 German and 11 African patients were analyzed as described under (A). Levels are normalized to glyceraldehydes-3-phosphate dehydrogenase (GAPDH). Data are expressed as ∼fold change in mRNA transcript levels relative to German subjects. Horizontal bars represent median cathelicidin expression.</p

Expression of cathelicidin mRNA in human duodenal biopsies.

<p>Duodenal biopsies from 9 German and 12 African patients were analyzed by real-time PCR for cathelicidin mRNA expression. Levels are normalized to glyceraldehydes-3-phosphate dehydrogenase (GAPDH). Data are expressed as ∼fold change in mRNA transcript levels relative to German subjects. Horizontal bars represent median cathelicidin expression.</p

Clinical data of patients.

<p>Clinical data of patients.</p

Expression of cathelicidin mRNA, interleukin-8 (IL-8) and beta-defensin 2 (hbd2) in biopsies.

<p>From the gastric antrum (A) and corpus/fundus (B) of African and German patients. Data were correlated with helicobacter pylori (HP) infection status. Levels are normalized to glyceraldehydes-3-phosphate dehydrogenase (GAPDH). Data are expressed as ∼fold change in mRNA transcript levels relative to German subjects. Horizontal bars represent median cathelicidin expression. Cathelicidin and hbd2 levels were significantly increased in HP positive compared with HP negative patients. The inflammatory status measured by IL-8 expression correlated well with the HP infection status.</p