Visceral adipocytes: old actors in obesity and new protagonists in Crohn's disease?

Zulian, Alessandra; Cancello, Raffaella; Micheletto, Giancarlo; Gentilini, Davide; Gilardini, Luisa; Invitti, Cecilia

doi:10.1136/gutjnl-2011-300391

Cited by 97 publications

(86 citation statements)

References 34 publications

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“…16,17 Derangements are seen in the mesenteric fat wrapping, thickening, and shortening that characterize Crohn's disease. 18,19 This study was performed on cadaveric tissue, in which fixation may be suboptimal. However, as in previous studies, 20 architectural preservation was sufficient to satisfactorily characterize the microscopic appearance of mesocolon and related fascia.…”

Section: Discussionmentioning

confidence: 99%

The Mesocolon

et al. 2014

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Background: Colonic mobilization requires separation of mesocolon from underlying fascia. Despite the surgical importance of planes formed by these structures, no study has formally characterized their microscopic features. The aim of this study was to determine the histological and electron microscopic appearance of mesocolon, fascia, and retroperitoneum, prior to and after colonic mobilization. Methods: In 24 cadavers, samples were taken from right, transverse, descending, and sigmoid mesocolon. In 12 cadavers, specimens were stained with hematoxylin and eosin (3 sections) or Masson trichrome (3 sections). In the second 12 cadavers, lymphatic channels were identified by staining immunohistochemically for podoplanin. The ascending mesocolon was assessed with scanning electron microscopy. The above process was first conducted with the mesocolon in situ. The mesocolon was then surgically mobilized, and the process was repeated on remaining structures. Results: The microscopic structure of mesocolon and associated fascia was consistent from ileocecal to mesorectal level. A surface mesothelium and underlying connective tissue were evident throughout. Fibrous septae separated adipocyte lobules. Where apposed to retroperitoneum, 2 mesothelial layers separated mesocolon and underlying retroperitoneum. A connective tissue layer occurred between these (ie, Toldt's fascia). Lymphatic channels were evident both in mesocolic connective tissue and Toldt's fascia. After surgical separation of mesocolon and fascia both remained contiguous, the fascia remained in situ and the retroperitoneum undisturbed.Conclusions: The findings demonstrate that the contiguous mesocolon and retroperitoneum are separated by mesothelial and connective tissue layers. These properties generate the surgical planes (ie, meso-and retrofascial planes) exploited in colonic and mesocolic mobilization.

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Section: Discussionmentioning

confidence: 99%

The Mesocolon

et al. 2014

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“…Furthermore, mesenteric or ‘creeping' fat is a hallmark of severe CD and has been correlated with transmural inflammation, ulceration, and stricture formation [12]. Recently, it was reported that the visceral adipocytes of CD patients and patients with obesity exhibited similar upregulation of genes involved with inflammation and immunity [13]. In addition, a higher ratio of visceral to subcutaneous fat has been found in patients with complicated CD, compared to patients with mild disease [14].…”

Section: Introductionmentioning

confidence: 99%

Volumetric Fat Ratio and Not Body Mass Index Is Predictive of Ileocolectomy Outcomes in Crohn's Disease Patients

Connelly

Juza²,

Sangster³

et al. 2014

Dig Surg

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Background: Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD. Methods: One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry. Patient demographics and operative outcomes were recorded. Visceral (VA) and subcutaneous (SA) adiposity and abdominal circumference (AC) were analyzed on preoperative CT scans using Aquarius iNtuition software. A visceral/subcutaneous ratio (VSR) was calculated. Results: BMI correlated with SA (p = 0.0001), VA (p = 0.0001) and AC (p = 0.0001) but not VSR (p > 0.05). BMI, VA and AC did not predict surgical morbidity (p > 0.05). In multivariate regression analysis, family history of IBD (p = 0.009), high American Society of Anesthesiologists score (p = 0.02) and increased VSR (p = 0.03) were independent predictors of postoperative morbidity. Conclusions: The visceral/subcutaneous fat ratio is a more reliable predictor of postoperative outcomes in CD patients undergoing ileocolectomy than conventional adiposity markers such as BMI. Preoperative calculation of the visceral/subcutaneous fat ratio offers the opportunity to optimize high-risk surgical patients, thus improving outcomes.

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“…Again, on the one hand, a decrease NF-kB pathway activation (d e c re a s e dp I K B / I K Br a t i o )a n di n c re a s e dI L -1 0 expression in MAT of CD patients have been demonstrated, which suggest a possible antiinflammatory role of MAT [21,31]. On the other hand, STAT-1 transcription factor is activated in the MAT of CD patients, suggesting a potential role in the inflammatory process [31].…”

Section: Molecular Characteristics Of the Mesenteric Adipose Tissue Imentioning

confidence: 90%

“…A l t h o u g ha d i p o s et i s s u ei sa b l et oi n c r e a s eT N F -α secretion via leptin, a hormone produced by adipocytes [56], some studies in the literature did not find high levels of TNF-α in the MAT of CD, neither higher levels of IL-1B, IL6, IL8, IL23, and NF-KB activation [21,31,38,57]. Again, on the one hand, a decrease NF-kB pathway activation (d e c re a s e dp I K B / I K Br a t i o )a n di n c re a s e dI L -1 0 expression in MAT of CD patients have been demonstrated, which suggest a possible antiinflammatory role of MAT [21,31].…”

Section: Molecular Characteristics Of the Mesenteric Adipose Tissue Imentioning

confidence: 98%

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The Role of Mesenteric Adipose Tissue in Crohn’s Disease

Leal¹,

Pascoal²,

Silva³

et al. 2018

Adipose Tissue

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Inflammatory bowel disease (IBD) has become an increasingly frequent chronic health problem in the last few decades, particularly in developing countries. In young adults, one of the most common forms of IBD is Crohn's disease (CD). CD is a multifactorial genetic disease characterized by a transmural granulomatous inflammation that especially affects the terminal ileum and the colon. As it involves defective inflammatory pathways, the immune adaptive complex, and environmental factors, this disease has periods of remission and recurrence followed by diarrhea, abdominal pain, and malnutrition, which often lead to lumen bowel stenosis associated to multiple fistulas. In addition, the growth of mesenteric adipose tissue (MAT) near the affected intestinal area is a hallmark of CD. Evidence linking the development of mesenteric and intestinal alterations in CD is increasing. The aim of this chapter is to address adipose tissue in general, the morphological and functional differences between its compartments, the main characteristics of MAT in CD, and its possible role in the etiopathology of this immune-mediated disease.

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Visceral adipocytes: old actors in obesity and new protagonists in Crohn's disease?

Cited by 97 publications

References 34 publications

The Mesocolon

The Mesocolon

Volumetric Fat Ratio and Not Body Mass Index Is Predictive of Ileocolectomy Outcomes in Crohn's Disease Patients

The Role of Mesenteric Adipose Tissue in Crohn’s Disease

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