Achalasia—An Autoimmune Inflammatory Disease: A Cross-Sectional Study

• Published in: Journal of immunology research 2015-01, Vol.2015 (2015), p.1-18
• Main Authors: Flores-Nájera, A., Villa-Baños, A., Ceballos, J. C., Torres-Villalobos, Gonzalo, Coss-Adame, E., Enríquez, A. B., Martín-del-Campo, L. A., Nuñez-Álvarez, Carlos, Valdovinos, Miguel A., Gamboa-Domínguez, A., Aguilar-León, D., Furuzawa-Carballeda, Janette, Svarch, A. E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antigens; Autoantibodies - immunology; Autoimmune diseases; Autoimmune Diseases - immunology; Autoimmune Diseases - pathology; Autoimmune Diseases - virology; Biomarkers; Biopsy; Case-Control Studies; Cross-Sectional Studies; Disease; Esophageal Achalasia - immunology; Esophageal Achalasia - pathology; Esophageal Achalasia - virology; Female; Fluorescent Antibody Technique, Indirect - methods; Herpes Simplex - immunology; Herpes simplex virus 1; Herpes viruses; Herpesvirus 1, Human - immunology; HIV; Human immunodeficiency virus; Humans; Hypotheses; Immune system; Immunohistochemistry - methods; Immunology; Infections; Inflammation - immunology; Inflammation - pathology; Inflammation - virology; Lymphocytes; Male; Middle Aged; Myenteric Plexus - immunology; Myenteric Plexus - pathology; Myenteric Plexus - virology; Nutrition research; Patients; Phosphatase; Studies; Viral infections
• ISSN: 2314-8861; 2314-7156
• DOI: 10.1155/2015/729217

Idiopathic achalasia is a disease of unknown etiology. The loss of myenteric plexus associated with inflammatory infiltrates and autoantibodies support the hypothesis of an autoimmune mechanism. Thirty-two patients diagnosed by high-resolution manometry with achalasia were included. Twenty-six specimens from lower esophageal sphincter muscle were compared with 5 esophagectomy biopsies (control). Immunohistochemical (biopsies) and flow cytometry (peripheral blood) analyses were performed. Circulating anti-myenteric autoantibodies were evaluated by indirect immunofluorescence. Herpes simplex virus-1 (HSV-1) infection was determined by in situ hybridization, RT-PCR, and immunohistochemistry. Histopathological analysis showed capillaritis (51%), plexitis (23%), nerve hypertrophy (16%), venulitis (7%), and fibrosis (3%). Achalasia tissue exhibited an increase in the expression of proteins involved in extracellular matrix turnover, apoptosis, proinflammatory and profibrogenic cytokines, and Tregs and Bregs versus controls ( P < 0.001 ). Circulating Th22/Th17/Th2/Th1 percentage showed a significant increase versus healthy donors ( P < 0.01 ). Type III achalasia patients exhibited the highest inflammatory response versus types I and II. Prevalence of both anti-myenteric antibodies and HSV-1 infection in achalasia patients was 100% versus 0% in controls. Our results suggest that achalasia is a disease with an important local and systemic inflammatory autoimmune component, associated with the presence of specific anti-myenteric autoantibodies, as well as HSV-1 infection.