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- Title
Patients with Primary (Idiopathic) Achalasia Have Circulating Peripheral Blood Mononuclear Immune Cells That Are Hyper- Reactive To the Herpes- Simplex -1 Virus.
- Authors
Lau, K. W.; McCaughey, C.; Coyle, P. V.; Murray, L. J.; Johnston, B. T.
- Abstract
Introduction: Achalasia is the best characterized oesophageal motor disorder but the aetiology is unknown. The pathology seen in achalasia consists of a decrease in nitric oxideproducing neurones and the presence of an activated T-cell inflammatory infiltrate in the myenteric plexus1. Certain Human Leucocyte Antigen (HLA) class II alleles are also more prevalent in patients with primary achalasia. These factors suggest that an autoimmune mechanism may be involved in the pathogenesis of primary achalasia. The stimulus initiating this is unknown but could involve the Herpes simplex -1 virus (HSV -1). A previous study has demonstrated the existence of oesophageal mononuclear immune cells reactive to HSV -1 antigens in an in- vitro setting. Aims & Methods: The aim of this study is to test the hypothesis that circulating peripheral blood mononuclear cells in patients with primary achalasia may be reactive to HSV- 1. Whole blood culture experiments were conducted with heparinised peripheral venous blood obtained from 151 patients with primary achalasia and 118 healthy controls. Whole blood was cultured in the presence of ultraviolet inactivated HSV - 1 (multiplicity of infection of 1 TCID50 / lymphocyte) or conditioned cell culture media. Reactivity of mononuclear cells to viral antigens was quantified by measuring expression of the cytokine gene interferon - gamma using Taqman® Real Time Polymerase Chain Reaction. Data are expressed as cytokine fold change corresponding to ratio of interferon - γ messenger RNA copies produced in antigen stimulated versus unstimulated cells. Interferon- γ fold change was compared between cases and controls using the unpaired student's- t test after log transformation and expressed as median (interquartile range). Results: The interferon- γ fold change was higher in cases 61.33 (20.54 - 217.00) than controls 49.67 (10.05 - 157.05). Mean fold change difference between cases and controls was 1.66 times (95% confidence interval 1.17 - 2.34, p = 0.02). Conclusion: The results of this study indicate that mononuclear immune cells hyper- reactive to HSV- 1 are present in the peripheral blood of patients with primary achalasia and may contribute to the pathological changes observed in the myenteric plexus.
- Subjects
MOVEMENT disorders; AUTOIMMUNE diseases; BLOOD vessels; HERPES simplex virus; CELLS; BLOOD
- Publication
Ulster Medical Journal, 2008, Vol 77, Issue 1, p61
- ISSN
0041-6193
- Publication type
Article