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Comparative Study
. 2007;11(5):R116.
doi: 10.1186/cc6170.

Cellular turnover and expression of hypoxic-inducible factor in acute acalculous and calculous cholecystitis

Merja Vakkala  1 , Jouko J Laurila, Juha Saarnio, Vesa Koivukangas, Hannu Syrjälä, Tuomo Karttunen, Ylermi Soini, Tero I Ala-Kokko
Affiliations
Comparative Study

Cellular turnover and expression of hypoxic-inducible factor in acute acalculous and calculous cholecystitis

Merja Vakkala et al. Crit Care. 2007.

Abstract

Introduction: Epithelial corrective and destructive mechanisms have not been studied in inflammatory gallbladder disease.

Methods: Epithelial apoptosis, cell proliferation and expression of hypoxia-inducible factor (HIF)-1alpha were compared in gallbladders from patients with acute acalculous cholecystitis (AAC; n = 30) and acute calculous cholecystitis (ACC; n = 21), and from patients undergoing surgery for other reasons (normal gallbladders; n = 9), which were removed during open cholecystectomy. The immunohistochemical stains included antibodies to Ki-67 (proliferation), M30 (apoptosis) and HIF-1alpha. Proliferation and apoptosis were expressed as percentages of positive cells. HIF-1alpha expression was expressed as absent, weak, or strong.

Results: Apoptosis (median [25th to 75th percentile]) was significantly increased in AAC (1.31% [0.75% to 1.8%], P < 0.001) and ACC (1.10% [0.63% to 1.64%], P = 0.001), compared with control samples (0.20% [0.07% to 0.45%]. The proliferation rate was significantly increased in AAC (8.0% [4.0% to 17.0%], P < 0.001) and ACC (14% [7.5% to 26.5%], P = 0.001) compared with control samples (1.0% [1.0% to 3.0%]). Strong HIF-1alpha staining was observed in 57% of AAC, in 100% of ACC and in 44% of control specimens (P < 0.001). Intense HIF-1alpha expression was associated with increased cell proliferation (P = 0.002).

Conclusion: Cell proliferation and apoptosis were increased in AAC and ACC, as compared with normal gallbladders. Expression of HIF-1alpha was lower in AAC than in ACC.

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Figures

Figure 1
Figure 1
Immunohistochemical staining in AAC, ACC and normal gallbladder mucosa. (a) Ki67 expression in acute acalculous cholecystitis (AAC). (b) One M30-positive apoptotic cell in AAC. (c) Hypoxia-inducible factor (HIF)-1α expression in AAC; nuclear expression and moderate cytoplasmic expression can be seen in this sample. (d) Abundant Ki67 expression in acute calculous cholecystitis (ACC). (e) two M30-positive cells in ACC. (f) strong nuclear expression of HIF-1α in ACC. (g) Ki67 in control sample. (h) M30-positive cell in control sample. (i) Abundant nuclear and weak cytoplasmic expression of HIF-1α in control sample.
Figure 2
Figure 2
Epithelial cell proliferation and apoptosis. Provided are scatter plots showing epithelial cell (a) proliferation and (b) apoptosis in acute acalculous cholecystitis (AAX), acute calculous cholecystitis (AXX) and normal gallbladder. In each group, cases with a high hypoxia-inducible factor (HIF)-1α expression are shown with solid circles and those with low HIF-1α expression with open circles. Line indicates the median for each group.
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