Immunohistochemical and electron microscopic examination of Cajal cells in ureteropelvic junction obstruction

Eken, Alper; Erdoğan, Şeyda; Kuyucu, Yurdun; Seydaoğlu, Gülşah; Polat, Sait; Satar, Nihat

doi:10.5489/cuaj.11293

Cited by 9 publications

(14 citation statements)

References 24 publications

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“…Majority of the studies suggest that the overall CLC density at UPJ is reduced in individuals with UPJO compared to controls ( 33 , 38 , 40 , 42 , 45 ), which is consistent with the results of our quantitative synthesis. A constellation of gastrointestinal motility diseases including achalasia cardia ( 52 ) and Hirschsprung's disease ( 53 ) are associated with depletion of Cajal cells, while reduction of Cajal cell density in small intestinal segments of inflammation or obstruction significantly improves when treating the pathology causing inflammation or removal of obstruction ( 54 , 55 ).…”

Section: Discussionsupporting

confidence: 89%

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Variations in the Density and Distribution of Cajal Like Cells Associated With the Pathogenesis of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: Cajal like cells (CLCs) in the upper urinary tract have an ability to generate coordinated spontaneous action potentials and are hypothesized to help propel urine from renal pelvis into the ureter. The objective of this review was to describe the variations in the density and distribution of CLCs associated with ureteropelvic junction obstruction (UPJO).Materials and Methods: Studies comparing the density and distribution of CLCs in the human upper urinary tract in patients with UPJO and healthy controls were included in this systematic review. We searched online electronic databases; Ovid MEDLINE, Scopus, PubMed and Cochrane reviews for the studies published before October 31, 2020. A meta-analysis was conducted to compare the density of CLCs at the ureteropelvic junction (UPJ) in patients with UPJO and matched controls.Results: We included 20 and seven studies in the qualitative and quantitative synthesis, respectively. In majority (55%) CLCs were located between the muscle layers of the upper urinary tract. The CLC density in the UPJ gradually increased with aging in both healthy subjects and patients with UPJO. The pooled analysis revealed that the density of CLCs at the UPJ was significantly low in patients with UPJO compared to the controls (SMD = −3.00, 95% CI = −3.89 to −2.11, p < 0.01).Conclusions: The reduction in CLC density at the UPJ in patients with UPJO suggests a contribution from CLCs in the pathogenesis of UPJO. Since age positively correlates with CLC density, it is imperative to carefully match age when conducting case control studies comparing the CLC density and distribution.Protocol Registration Number: CRD42020219882.

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Section: Discussionsupporting

confidence: 89%

“…Most studies ( 31 – 33 , 42 , 45 ) reported a lower density of CLCs in the UPJ of the patients with UPJO compared to the controls ( Table 2 ). On the contrary, Koleda et al ( 23 ), and Kuvel et al ( 22 ) found a comparatively higher density of CLCs at the UPJ in patients.…”

Section: Resultsmentioning

confidence: 98%

Variations in the Density and Distribution of Cajal Like Cells Associated With the Pathogenesis of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis

et al. 2021

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“…They concluded that in UPJO, a decrease in the number of ICC, as well as the changes in the morphologic structure of the ICC, indicates that these cells have a role in the pacemaker system and are associated with ureteral peristalsis. [ 15 ] Similar results were reported by Balikci et al . [ 16 ]…”

Section: Discussionsupporting

confidence: 86%

Immunohistochemistry in ureteropelvic junction obstruction and its correlation to postoperative outcome

Inugala

Ravikanth

Rao

et al. 2017

J Indian Assoc Pediatr Surg

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Aim:To investigate the correlation between the status of interstitial cells of Cajal (ICC) in ureteropelvic junction (UPJ) and the resected ureteric margin and the postoperative outcome of Anderson-Hynes pyeloplasty in UPJ obstruction (UPJO) and to compare the ICC in the UPJ and the resected margin of the normal ureter.Materials and Methods:An observational study was conducted over a period of 2 years at the Department of Pediatric Surgery at Niloufer Institute of Women and Child Health. Children with intrinsic UPJO who underwent Anderson-Hynes dismembered pyeloplasty were included in the study. Six months postoperatively, the patients were divided into two groups based on diuretic isotopic renogram using technetium-99m-labeled diethylene triaminepentaacetic acid. Group 1 comprised patients with good surgical outcome. Group 2 comprised patients with a poor outcome. The histologic specimens were evaluated for ICC, and the immunohistochemical findings were correlated with the outcome.Results:Twenty-five patients were included in this study (19 male and 6 female). Seventy-six percent of patients were under the age of 1 year. Group 1 had 23 cases and Group 2 had 2 cases. Out of the two patients with a poor outcome, one had negative grading at the UPJ and one had positive grading. Both these patients had a negative grading at the lower resected margins. More number of patients (24%) had +++ grading at the lower resected margin when compared to the UPJ (8%).Conclusion:This is the first study which correlates the status of ICC in UPJ with the outcome of pyeloplasty in pediatric patients. Both the cases with bad outcome had no ICC at the lower margin of the resected specimen and one case had no ICC at the UPJ. There is a statistically significant difference (P = 0.001) in the number of ICC at the UPJ and the resected margin.

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“…[ 3 ] Some studies suggest the role of neuronal factors or decrease in the number of pacemaker cells or combined theory involving both nerves and muscles, as a possible etiology. [ 4 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

“…When labelled with antibodies to proto-oncogene c-kit, they can be detected through immunohistochemistry. [ 6 7 ] In the gastrointestinal tract, the loss of this pacemaker activity of these cells has been established in the etiopathogenesis of Hirschsprung's disease and intestinal pseudo-obstruction. [ 8 9 10 ] It has been postulated that the loss of initiation, propagation, and coordination of the upper urinary tract peristalsis due to paucity of ICC may have a role in congenital UPJO.…”

Section: Introductionmentioning

confidence: 99%

Influence of interstitial cells of cajal in congenital ureteropelvic junction obstruction

Pande

Dey

Chand

et al. 2020

J Indian Assoc Pediatr Surg

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Background: The etiopathogenesis of congenital ureteropelvic junction obstruction (UPJO) has been inconclusive in spite of the numerous studies carried out to find the possible causative factor. The results of different studies have been conflicting and contradictory. It has been postulated that the interstitial cells of Cajal (ICC) are the pacemaker cells located in the ureteropelvic junction (UPJ) and regulate the peristalsis in this region. Paucity of these cells may be one of the causative factors for congenital UPJO although there is no clear consensus on this issue. Therefore, the present study has been carried out to ascertain the role of ICC as one of the possible etiological factors for congenital UPJO. The aim of this study is to first identify the presence of ICC at UPJ, second to compare the average number of ICC in congenital UPJO with a control population without UPJO, and third to ascertain whether any correlation exists between the number of ICC and postoperative improvement in function of the affected kidney. Materials and Methods: A total number of 30 patients who underwent dismembered Anderson-Hynes pyeloplasty for congenital UPJO between June 2016 and November 2017, were compared with seven controls who underwent nephroureterectomy for various other reasons. The specimen was subjected to immunohistochemistry (IHC), and a quantitative comparison was made for the ICC between cases and controls. The preoperative and postoperative function was evaluated by renal diuretic scintigraphy. Results: The disease was more common among males in the ratio of 6.5:1, and there was a predominance of the left-sided involvement. In the studied cases, the average number of ICC seen for every high-power field (hpf) was 4.86 ± 0.76/hpf, whereas in control it was 11.74 ± 0.86/hpf ( P = 0.04). The postoperative outcome, as measured by the improvement in split renal function, did not have any correlation with the number of ICC. Conclusion: The ICC are present at the UPJ and can be detected by immunohistochemistry due to their CD117 positivity. These cells are significantly low at this site in cases of congenital UPJO when compared to controls without any obstruction. The number of ICC bears no correlation to the postoperative improvement in function.

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Immunohistochemical and electron microscopic examination of Cajal cells in ureteropelvic junction obstruction

Abstract: In UPJ obstruction, a decrease in the number of Cajal cells, as well as the changes in the morphologic structure of the Cajal cells, indicates that these cells have a role in the pacemaker system and are associated with ureteral peristalsis.

Cited by 9 publications

References 24 publications

Variations in the Density and Distribution of Cajal Like Cells Associated With the Pathogenesis of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis

Variations in the Density and Distribution of Cajal Like Cells Associated With the Pathogenesis of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis

Immunohistochemistry in ureteropelvic junction obstruction and its correlation to postoperative outcome

Influence of interstitial cells of cajal in congenital ureteropelvic junction obstruction

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