Pathomorphological feature of chronic pancreatitis (CP) is the development of pancreatic fibrosis with the accumulation of various collagen types, tubulin, fibronectin, laminin, and also intermediate filament proteins produced by activated pancreatic stel

Authors

  • T.V. Turovskaya
  • A.M. Gnilorybov
  • L.V. Vasilyeva
  • V.B. Kostogryz
  • M.S. Goncharuk

DOI:

https://doi.org/10.14739/2310-1237.2013.1.14537

Keywords:

chronic heart failure, diagnosis, treatment

Abstract

Pathomorphological feature of chronic pancreatitis (CP) is the development of pancreatic fibrosis with the accumulation of various collagen types, tubulin, fibronectin, laminin, and also intermediate filament proteins produced by activated pancreatic stellate cells (PSCs), which express the cytoskeletal α-smooth muscle actin (α-SMA).

The aim of the research: determination of immunophenotype and proliferative activity of pancreatic stellate cells as well as the main histotopographic components of severe pancreatic fibrosis and accumulation of collagen I, III and IV types in pancreas at CP.

Materials and methods. Histological, histochemical (Van Gieson's and Masson's trichrome staining), immunohistochemical (α-SMA, vimentin, desmin, fibronectin, Ki-67, collagen I, III and IV types) and morphometric studies (Image J program) of accumulation of various collagen types, represented in standard unit of optical density (SUOD), were held at pancreas biopsies of 30 patients (35-72 years old) with CP.

Results. It was found that development of severe pancreatic fibrosis is promoted by proliferation and increase of α-SMA+, vimentin+, desmin+ activated stellate cells and deposition of significant amount of collagen I, III, IV types and fibronectin in pancreas that are synthesized by PSCs. In areas of severe fibrosis Ki-67 expression is detected in the nuclei of at least 25% of PSCs, that corresponds to relatively low levels of proliferation. Four components of severe pancreatic fibrosis: circular-periductal fibrosis involving the large ducts of the pancreas, laminar fibrosis in extensive fibrous fields between large ducts and acinar tissue, as well as tape-like interlobular and septal-periacinar intralobular pancreatic fibrosis are identified in patients with CP.

Conclusion. Morphological manifestation of severe circular-periductal pancreatic fibrosis is the presence of significant concentric fibrosis around the large ducts with atrophy and replaceable fibrosis of acinar tissue around the ducts, and the presence of inflammatory cell infiltration in fibrous areas. A large number of α-SMA-positive PSCs, and significant deposition of collagen are revealed in the wall of the large ducts and in the area of periductal fibrosis: according to morphometric data the area of accumulation of type I collagen was 24,09 ± 0,92 SUOD, type III collagen - 33.21 ± 1,24 SUOD, type IV collagen - 17,78 ± 0,84 SUOD.

Pathomorphological signs of severe laminar fibrosis are extensive fibrous fields between large ducts and pancreatic acinar tissue containing large amount of α-SMA-positive stellate cells and collagen depositions. According to morphometric data area of collagen type I accumulation in the fields of laminar fibrosis was 24,09 ± 0,72 SUOD, type III collagen - 22,68 ± 0,54 SUOD, type IV collagen - 15,34 ± 1,15 SUOD.

Morphological manifestations of severe pancreatic interlobular and intralobular fibrosis are diffused tape-like interlobular fibrosis, involving the most lobules, as well as septal-periacinar intralobular fibrosis with acinar atrophy and reorganization of pancreatic lobules. These zones show increased number of activated α-SMA-positive PSCs and significant deposition of collagen. According to morphometric data accumulation of type I collagen was 20,48 ± 0,98 SUOD, type III collagen - 25,04 ± 0,71 SUOD, type IV collagen - 18,70 ± 0,86 SUOD in these zones.

References

Жаринов О.И. Проблема впровадження сучасних принципів лікування серцевої недостатності у клінічній практиці / Жаринов О.И.// Медицина світу. – 2000. – Т. 9, №2. – С. 66–69.

Кобалава Ж.Д. Мочевая кислота – маркер и/или новый фактор риска развития сердечно-сосудистых осложнений? / Кобалава Ж.Д., Котовская Ю.Я., Толкачева Я.Я., Караулова Ю.Л. // Клин. Фармакол., тер. – 2002. – Т. 11, №3. – С. 32–39.

Коваленко В.М. Діагностика та лікування фібриляції передсердь: Рекомендації робочої групи по порушенням серцевого ритму Асоціації кардіологів України / Коваленко В.М., Дзяк Г.В., Коркушко А.В. – К., 2011. – С. 28–56.

Романенко В.В. Фибрилляция предсердий и хроническая сердечная недостаточность: стратегия и тактика лечения / Романенко В.В., Романенко З.В. // Мед.новости. – 2008. – №11. – С. 31–36.

Руководство по кардиологии / Под ред. В.Н. Коваленко. – К.: МОРИОН, 2008. – 1424 с.

Сидоренко Г.И. Актуальные аспекты проблемы сердечной недостаточности / Сидоренко Г.И., Комиссаров С.М., Золотухина С.Т. // Междунар. Мед. Журн. – 2005. – Т. 1., №1. – С. 6–9.

Cleiland I.C. Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomized controlled trial / Cleiland I.C., Penneli D.I., Ray S.G. et al. // Lancet. – 2003 – Vol. 362. – P. 14–21.

Cohn J.N. Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure / Cohn J.N., Tognoni G. // N. Engl. J. Med. – 2001. – Vol. 3445. – P. 1667–1675.

Cooper L.T. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American College of Cardiology and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of Cardiology / Cooper L.T., Baughman K.L., Feldman A.M. et al. // Eur. Heart J. – 2007 – Vol. 28. – P. 3076–3093.

Dargie H.I. Heart failure – implications of the true size of the problem / Dargie H.I., McMurray I.I., McDonach T.A. // J. Intern. Med. – 1996. – Vol. 39, №4. – P. 309–315.

Devereux R.B. Left ventricular diastolic disfunction: early diastolic relaxation and late diastolic compliance / Devereux R.B. // J. Am. Coll. Cardiol. – 1989. – Vol. 13. – P. 337–339.

Dickstein K. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the heart failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) / Dickstein K., Cohen-Sofal A., Fillipatos G. et al. // Eur. Heart. J. – 2008. – Vol. 29, №19. – P. 2388–2442.

Eckardt L. Arrhythmias in heart failure: current concept of mechanism and therapy / Eckardt L., Havercamp W., Johna R. et al. // J. Cardiovasc. Electrophys. – 2000. – Vol. 11, №1. – P. 106–170.

Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group // N. Engl. J. Med. – 1987. – Vol. 316. – P. 1429–1435.

Flather M.D. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular disfunction: a systematic overview of data from individual patients. ACE-inhibitor myocardial infarction Collaborative Group / Flather M.D., Yusuf S., Kober L. et al. // Lancet. – 2000. – Vol. 355. – P. 1575–1581.

GISSI-HF investigators. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISS-HF trial): a randomised, double-blinnd, placebo-controlled trial // Lancet. – 2007. – Vol. 369. – P. 1090–1098.

Goebel I.A. Rational use of diuretics in acute decompensated heart failure / Goebel I.A., Van Bakel A.B. // Curr. Heart Fail. Rep. – 2008. – Vol. 5. – P. 153–162.

Hare I. Uric acid predicts clinical outcomes in heart failure: insights regarding the role of xanthine oxidase and uric acid in disease pathophysiology / Hare I., Johnson R. // Circulation. – 2001. – V. 107. – P. 1951–1953.

Hoffman P.R. Public relations for the World Health Organization. World Health Report / Hoffman P.R. – Geneva.

Icogg C. Neurohumoral pathways in heart failure with preserved systolic function / Icogg C., Mc Murray // Prog. Cardiovasc. Dis. – 2005. – Vol. 47. – P. 357–366.

John J.V. McMurray ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure Association (HFA) of the ESC / John J.V. McMurray, Stamatis Adamopoulos, Stefan D. Anker et al. // Eur. Heart. J. – 2012. – №33. – P. 1787–1847.

McMurray I.I. CHARM investigation and committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial / McMurray I.I., Ostergen I., Swedberg I.C. et al. // Lancet. – 2003. – Vol. 362. – P. 767–771.

Nagush S.F. Recommendations for the evaluation of left ventricular diastolic function by electrocardiography / Nagush S.F., Appleton C.P., Gillebert T.C. et al. // J. Am. Soc. Echocardiogr. – 2009. – Vol. 22, №2. – P. 107–133.

Palmieri V. Reproductibility of Doppler echocardiographic assessment of left ventricular diastolic function in multicenter setting / Palmieri V., Innocenti F., Pini R., Celentrano A. // J. Am. Soc. Echocardiogr. – 2005. – Vol. 18, №2. – P. 99–106.

Pitt B. Тhe effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigation / Pitt B., Jamad F., Remme W.I et al. // N. Engl. J. Med. – 1999. – Vol. 341. – P. 709–717.

Sever P. From evidence to practice / Sever P. // Eur. Heart. J. – 2003. – Vol. 24. – P. 987–1003.

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Published

2013-06-21

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1.
Turovskaya T, Gnilorybov A, Vasilyeva L, Kostogryz V, Goncharuk M. Pathomorphological feature of chronic pancreatitis (CP) is the development of pancreatic fibrosis with the accumulation of various collagen types, tubulin, fibronectin, laminin, and also intermediate filament proteins produced by activated pancreatic stel. Pathologia [Internet]. 2013Jun.21 [cited 2024Dec.19];(1). Available from: http://pat.zsmu.edu.ua/article/view/14537

Issue

No. 1 (2013)

Section

Review

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