Intestinal fine structure in Crohn's disease. Lysosomal inclusions in epithelial cells and macrophages.

Abstract

Resected intestines from eight patients with Crohn's disease and three control cases were investigated by transmission electron microscopy. Characteristic changes were observed in the mucosa of all Crohn's disease specimens, most typically an infiltration of numerous macrophages into the propria. These cells displayed large lysosomes with inclusions which were mainly dense, irregularly shaped and composed of aggregated particles and bizarre-shaped, myelin-like figures. Similar inclusions were also found in the lysosomes of the surface epithelial cells and the macrophages in the submucosa. This latter layer otherwise consisted of an oedematous, collagenous connective tissue. The muscularis appeared structurally unaffected. Qualitatively, the findings were almost identical in all patients with Crohn's disease, but varied quantitatively without any clear correlation with the clinical histories. Moreover, in all cases typical alterations were found not only in the macroscopically most clearly affected parts of the intestines, but also in grossly normal regions, close to the margins of resection. The analogy of the fine structural findings with those of granulomas produced by injection of bacteria into experimental animals suggests that a microbial invasion of the intestinal wall may have initiated the disease. It therefore seems reasonable to assume that the lysosomal inclusions we observed represent partly degraded bacteria. More occasionally, virus-like particles were found within the lysosomes of the epithelial cells and the macrophages in the underlying propria. In view of the diffuse spread of the alterations it seems possible that there exists a generalized defect in the barrier function of the intestine in Crohn's disease. This could lead to passage of bacteria and/or other agents into the mucosa, followed by an influx of inflammatory cells from the blood. Storage of non-degradable microbial components in macrophages could then be responsible for the initiation and propagation of a chronic inflammatory process, similar to that of other granulomatous disorders.