Mixed Gastric- and Intestinal-type Metaplasia Is Formed by Cells with Dual Intestinal and Gastric Differentiation
Division of Oncological Pathology, Aichi Cancer Center Research Institute, Nagoya, Japan (TN,YI,HN,HT,K-iI,TT,MT) and Second Department of Internal Medicine, Wakayama Medical College, Wakayama City, Japan (TN,MI)
Correspondence to: Yuzuru Ikehara MD, PhD, Division of Oncological Pathology, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. E-mail: yikehara{at}aichi-cc.jp
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Summary |
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(J Histochem Cytochem 53:7585, 2005)
Key Words: intestinal metaplasia MAC5AC MUC2 villin CD10 human stomach
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Introduction |
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According to this classification, I-type IM glands are solely comprised of intestinal phenotypic cells, whereas GI-mixed-type IM glands also contain gastric phenotypic cells. Interestingly, although the number of gastric cells varies as much as those in a gastric-predominant or an intestinal-predominant type, GI-mixed-type IM glands appear to gradually become I-type IM glands (Inada et al. 1997; Tatematsu et al. 2003
). The exact mechanisms by which these two kinds of phenotype cells or phenotype shifts come to be produced have yet to be determined, but at least two explanations are possible. The first is that aberrantly expressed Cdx1 and/or Cdx2 transcriptional factors, mammalian homologs of the caudal-related homeobox genes, may play an important role in such processes (Silberg et al. 1997
; Mizoshita et al. 2001
; Tsukamoto et al. 2003
; Yuasa 2003
). The other would be that some genetic alterations such as methylation occur in stem cells leading them to supply such various cell types, especially as seen in GI-mixed-type IM in our classification, resulting in the phenotype change caused by their accumulation (Kang et al. 2001
,2003a
,b
; Kim et al. 2004
; Lee et al. 2004
).
Immunohistochemical techniques are widely used to identify intestinal and gastric cell differentiation for the classification of gastric cancers and IM (Inada et al. 1997; Reis et al. 1999
; Inada et al. 2001
; Jass and Walsh 2001
; Mizoshita et al. 2001
; Silva et al. 2002
; Kawachi et al. 2003
; Tatematsu et al. 2003
). To date, a preferred method to evaluate IM and gastric cancers utilizes the anti-mucin core proteins 5AC (MUC5AC) and 6 (MUC6) together with anti-CD10, anti-villin, and anti-MUC2 antibodies. Mucin core proteins comprise an expanded gene family consisting of at least 19 members (Tanaka et al. 1991
; Gum et al. 2002
; Chen et al. 2003
; Ringel and Lohr 2003
), of which MUC5AC, MUC6 and MUC2 genes are homologous to each other and are localized at chromosome 11p15.5 within a 400-kbp gene span (Pigny et al. 1996
; Winterford et al. 1999
). Their expressions might be differentially regulated by the restricted MUC5AC presence on surface epithelial cells (Reis et al. 1997
), MUC6 on cells in the glandular compartment of pyloric mucosa (Ho et al. 1995
; Reis et al. 2000
), and MUC2 in the goblet cells of small and large intestines, and on IM (Jass 2000
). A secreting endopeptidase, CD10 (Landry et al. 1994
; Sezaki et al. 2003
), and one of the actin-binding cytoskeletal proteins, villin (Landry et al. 1994
; MacLennan et al. 1999
; Pinto et al. 1999
), are also observed in intestinal cells, whose expressions indicate absorptive-cell differentiation in IM (Landry et al. 1994
). Expressions of these molecules are widely used to evaluate gastric cancers whether the differentiation direction is toward gastric or intestinal phenotype.
Using an adaptation of this approach to investigate IM glands, it has been demonstrated that small populations of MUC2-positive cells containing either MUC5AC or MUC6 are present in IM glands (Ho et al. 1995; Inada et al. 1997
,2001
; Reis et al. 1999
,2000
; Tatematsu et al. 2003
). However, it remains unclear whether these glands, probable GI-mixed IM glands, are composed of dual phenotype cells with intestinal and gastric differentiation. In the present study we evaluated the co-expression of MUC5AC and MUC2, MUC5AC and villin, and MUC5AC and CD10 in GI-mixed-type IM glands using multiple immunofluorescent staining techniques at the single-cell level. The combined use of these markers succeeded in providing evidence of cells with both gastric and intestinal phenotypes in IM.
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Materials and Methods |
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Antibodies
Table 1 shows the characteristics of mouse monoclonal antibodies (MAbs) used in this study. To specifically detect the immune reactions with two respective mouse MAbs, we employed Zenon Mouse IgG-labeling kits to directly label the MAbs with either AlexaFluor 488 or AlexaFluor 568 (Molecular Probes; Eugene, OR). Fluor-labeled MAbs were prepared immediately prior to use, according to the suppliers' protocols. The optimal concentrations of primary MAbs were determined empirically, and the final concentrations were 1:100 of anti-MUC5AC, 1:100 of anti-CD10, and 1:5000 of anti-villin MAbs. In all cases, isotype-matched monoclonal antibodies were used as a negative control.
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Immunofluorescence and Confocal Laser-scanning Fluorescence Microscopy
Multicolor-stained tissues with AlexaFluor 488, AlexaFluor 568, and DAPI were observed using an Olympus BH5 fluorescence microscope (Olympus; Tokyo, Japan) equipped with a xenon arc lamp and an appropriate filter set. Confocal laser scanning was performed with the Radiance 2100 K-3 system (BioRad; Clinisciences S.A., Montrouge, France) that employs optical fibers both in the illumination source and the detection aperture. This system was equipped with a 50-mW Crypton-Argon laser and filters allowing excitation with both a 488-nm and a 560-nm laser line. Two channels were available for simultaneous data acquisition: Channel 1 (displayed as green) could use a 510550-nm bandpass filter and either a 515-nm or a 530-nm longpass filter, while Channel 2 (displayed as red) could include either a 550-nm or 590-nm longpass filter.
Image Analysis
All images were recorded by a digital video camera and converted to TIFF files. Merged images were made using Adobe Photoshop software (Adobe Systems; San Jose, CA).
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Results |
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Co-expression of MUC2 and MUC5AC on GI-mixed-type IM
As shown in Figure 1, intestinal and gastric differentiation makers were detected in IM glands. In the first series of experiments using such specimens, we examined the expression of MUC2 as a marker for intestinal goblet cells and that of MUC5AC as a marker for gastric-surface columnar cells. Surface columnar epithelial cells exhibited MUC5AC without MUC2 expression in normal gastric mucosa, while goblet cells of the intestinal or I-type IM exhibited MUC2 without MUC5AC, as demonstrated in previous studies (Figures 2A and 2C) (Inada et al. 1997,2001
; Tatematsu et al. 2003
). GI-mixed-type IM glands, which were identified by the presence of both MUC5AC and MUC2 in a single gland (Figure 2B), demonstrated both the antigens in glands with a differential positive cell ratio. MUC2-positive cells showed a goblet cell-like feature with MUC5AC expression that included the MUC2 epitope in their cytoplasm of determined GI-mixed-type IM glands (Figure 2B). This result indicates that GI-mixed-type IM glands include cells sharing both gastric and intestinal phenotypes. Interestingly, the co-expressed MUC2 and MUC5AC epitope was not completely colocalized in their cytoplasm. To examine the differential cellular localization between MUC2 and MUC5AC in GI-mixed-type IM cells in more detail, we used a confocal laser-scanning microscope. MUC2 was clearly observed at the center of the cytoplasm, which was surrounded by the MUC5AC-expressing area (Figures 3A3F), suggesting that MUC2 and MUC5AC are sorted in a differential manner.
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Co-expression of MUC5AC and Villin/CD10 in GI-mixed-type IM
In a second set of experiments, we examined MUC5AC as a marker for gastric surface columnar cells and either villin or CD10 as the other markers for intestinal cells to verify whether the GI-mixed-type IM glands exhibit both intestinal and gastric phenotypes. Both villin and CD10 have been widely used as specific markers to identify intestinal absorptive cells and are exclusively expressed at the brush borders of cells solely in I-type IM glands but not in gastric glands (Figures 4 and 5). GI-mixed-type IM glands were identified by the presence of MUC5AC and villin in individual glands (Figure 4). Villin was detected on the apical end of MUC5AC-positive cells in GI-mixed-type IM glands, whose expressed cell numbers increased with diminishing MUC5AC expression in the glands. It is noteworthy that CD10 expression was not always detected with villin at the brush border in GI-mixed IM glands (Figure 6) but was also occasionally localized in the cytoplasm (Figure 5). Its inclusion body-like appearance was the same as that reported in familial microvillus-inclusion body disease (Groisman et al. 2002). This inclusion body-like CD10 staining pattern is more apparent in GI-mixed-type IM glands with more abundant MUC5AC-expressing cells, but it disappears with declining MUC5AC expression.
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Discussion |
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The cells in GI-mixed-type IM glands exhibited MUC2 with MUC5AC in their cytoplasm (Figures 2 and 3), while the cells in I-type IM glands exhibited MUC2 in the peri-nuclear Golgi apparatus area. The subcellular localization of MUC2 appeared to shift from secretion vesicles to the Golgi apparatus area with a histological alteration from GI-mixed-type IM to I-type IM. A glycosylation change might be one of the probable explanations, since the MUC 2 antibody used in this study could detect only underglycosylated MUC2 core protein for the epitope as discussed in previous studies (Hong and Kim 2000; Shaoul et al. 2000
). In the present study we observed the enhanced anti-MUC2 antibody staining in I-type IM glands by alkali-catalyzed ß-elimination, which was similar to the MUC2 staining on GI-mixed-type IM glands. This result indicates that O-linked glycosylation limited the detection of MUC2 expression in goblet cells in I-type IM glands, suggesting that the difference between the higher glycosylated MUC2 in I-type IM glands and the lower glycosylated MUC2 in the goblet cells in the GI-mixed-type IM glands would be the other maturation indicator for goblet cells in IM glands.
The columnar epithelial cells, similar to the intestinal absorptive cells, were seen in GI-mixed-type IM glands that exhibited MUC5AC and either villin or CD10. Compared with villin-positive cells, CD10 was preferentially found in the faint MUC5AC-preserved columnar cells, suggesting that CD10 exists in cells of the more intestinalized GI-mixed-type IM glands (Figure 6). Analogously, in the development of fetal mouse small intestine, villin appears on the brush border prior to CD10 (Landry et al. 1994; Montgomery et al. 1999
). Villin is an actin-binding cytoskeletal protein essential for brush border formation in normal epithelial cells of the intestine, while CD10 is a brush border-associated neutral peptidase. Adapting these findings to human IM, the structural accomplishment of IMs such as villin expression might precede by functional maturations such as digestive enzyme, CD10 expression. Moreover, it may be reasonable to assume that villin-positive and CD10-negative cells in GI-mixed-type IM are functionally immature absorptive cells, and that the phenotype shift from GI-mixed-type IM to solely I-type IM is a kind of maturation. Furthermore, the expression of CD10 in the cytoplasm of columnar cells in GI-mixed IM (Figure 5) might support this idea, because it has been found in the surface enterocytes of familial microvillus inclusion disease due to the immaturity of CD10 (Groisman et al. 2002
).
Co-expression ratios of MUC5AC to MUC2, villin, or CD10 varied greatly in terms of establishing a dominant MUC5AC type or a MUC2/villin/CD10 dominant type. Based on these findings, the cells in mixed-type IM glands seem to be about to free themselves from the gastric phenotype, finally becoming solely I-type IM cells. As villin, CD10, and MUC2 expressions progressively increase, MUC5AC expression reciprocally diminishes. Gastric-type cells are gradually reduced and finally replaced by intestinal-type cells, leading to solely I-type IM. These results indicate that GI-mixed-type IM cells are multi-phenotypic, suggesting that the phenotype shift from a GI-mixed type to a solely I-type IM should occur in each cell over time (Figure 7).
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Acknowledgments |
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Footnotes |
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