Mo1726 Failure of Bilirubin-Mediated Immunosuppression Can Be Linked to Increased Efflux From Cells Driven by Heightened Activation of MDR1 Glycoprotein on T-Cells in Crohn's Disease

Abstract

Background: Lymphocyte infiltration into the intestinal mucosa is an important pathogenic feature of inflammatory bowel diseases (IBD). In case of dermatitis, lymphatics play a role as drainage route of lymphocytes from skin and an inhibition of lymphangiogenesis keeps lymphocytes remaining in the local area leading to exacerbate inflammation. However, the role of lymphatics in enterocolitis is not well understood. In this study, we examined changes in lymphatic densities and expression of lymphangiogenic factors in patients with IBD and in animal model of colitis, and investigated a role of lymphangiogenic using inhibitor of VEGF (vascular endothelial growth factor)-R3. Method: Colonic biopsies were obtained from 40 patients with ulcerative colitis (UC), 17 patients with Crohn's disease (CD), and controls. Messenger RNA expressions of lymphangiogenic factors, VEGFC & D, VEGFR3, podoplanin, Prox-1, and LYVE1 were determined using real time RT-PCR. Expression of CD34 and LYVE1 was studied immunohistochemically. In dextran sulfate sodium (DSS)-induced mice colitis, a VEGF-R3 kinase inhibitor (10mg/kg) was administered every day and the effects of lymphangiogenetic inhibition on activity of colitis and lymphatic density were determined in the colonic mucosa. Result: In the colonic mucosa of patients with UC and CD, the expressions of VEGFC, VEGFR3, podoplanin, and LYVE1 were significantly increased than the mucosa of control patients. The expression levels of podoplanin and LYVE1 were well correlated to endoscopic Matt's score in UC patients. By immunohistochemistry, the lymphatic densities in the colonic mucosa of IBD patients also increased compared to control patients. However, interestingly those densities were not significantly increased in the severely inflamed mucosa of IBD patients compared with those in the quiescent mucosa, suggesting that lymphangiogenesis and lymphatic drainage are not well organized in the severely inflamed mucosa. In murine colitis model, VEGF-R3 inhibition group showed significant aggravation of colitis such as shortening of colonic length and increase in the lymphocyte infiltration in the submucosa compared with DSS-treatment alone. Lymphatic densities decreased in the submucosa of VEGF-R3 inhibition group. Conclusions: The results of our study revealed that lymphangiogenic factors and lymphatic density are increased in both UC and CD patients. However, the density of lymphatic did not increase as inflammation advanced. Aggravation of colitis by lymphangiogenic receptor inhibition suggests that lymphatic networks may play some protective roles as exit of immune cells from intestinal mucosa, and that some mechanisms which block lympangiogenesis play aggravating role in severe IBD patients. In the severely inflamed conditions lymphatic drainage through lymphangiogenesis is not well functioning in IBD.