Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and Its Renal Sonological and Functional Correlation: A Prospective Observational Study

Overview

Journal J Indian Assoc Pediatr Surg

Specialty Pediatrics

Date 2023 May 17

PMID 37197239

Authors

Kumar Ashish

Simmi K Ratan

Yogesh Kumar Sarin

Nita Khurana

Jyoti Kumar

Affiliations

Soon will be listed here.

Abstract

Aims And Objectives: This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients.

Materials And Methods: A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters.

Results: The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction.

Conclusion: The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.

References

Koleda P, Apoznanski W, Wozniak Z, Rusiecki L, Szydelko T, Pilecki W . Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction. Int Urol Nephrol. 2011; 44(1):7-12. PMC: 3253995. DOI: 10.1007/s11255-011-9970-5. View

Apoznanski W, Koleda P, Wozniak Z, Rusiecki L, Szydelko T, Kalka D . The distribution of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. Int Urol Nephrol. 2013; 45(3):607-12. PMC: 3689466. DOI: 10.1007/s11255-013-0454-7. View

SLEATOR Jr W, BUTCHER Jr H . Action potentials and pressure changes in ureteral peristaltic waves. Am J Physiol. 1955; 180(2):261-76. DOI: 10.1152/ajplegacy.1955.180.2.261. View

Nandan R, Jain V, Agarwala S, Das P, Goel P, Kalaivani M . Evaluation of Interstitial Cells of Cajal-Like Cells at the Pelviureteric Junction in Children with Pelviureteric Junction Obstruction: A Prospective Study and Review of Literature. J Indian Assoc Pediatr Surg. 2022; 27(4):395-401. PMC: 9552655. DOI: 10.4103/jiaps.jiaps_103_21. View

Kuvel M, Canguven O, Murtazaoglu M, Albayrak S . Distribution of Cajal like cells and innervation in intrinsic ureteropelvic junction obstruction. Arch Ital Urol Androl. 2011; 83(3):128-32. View

Inugala A, Reddy R, Rao B, Reddy S, Othuluru R, Kanniyan L . Immunohistochemistry in Ureteropelvic Junction Obstruction and Its Correlation to Postoperative Outcome. J Indian Assoc Pediatr Surg. 2017; 22(3):129-133. PMC: 5473296. DOI: 10.4103/jiaps.JIAPS_254_16. View

Solari V, Piotrowska A, Puri P . Altered expression of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. J Urol. 2003; 170(6 Pt 1):2420-2. DOI: 10.1097/01.ju.0000097401.03293.f0. View

Dhillon H . Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol. 1998; 81 Suppl 2:39-44. DOI: 10.1046/j.1464-410x.1998.0810s2039.x. View

Takaki M . Gut pacemaker cells: the interstitial cells of Cajal (ICC). J Smooth Muscle Res. 2003; 39(5):137-61. DOI: 10.1540/jsmr.39.137. View

10.

Sanders K . A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract. Gastroenterology. 1996; 111(2):492-515. DOI: 10.1053/gast.1996.v111.pm8690216. View

11.

Santicioli P, Maggi C . Myogenic and neurogenic factors in the control of pyeloureteral motility and ureteral peristalsis. Pharmacol Rev. 1998; 50(4):683-722. View

12.

Golenhofen K, Hannappel J . Normal spontaneous activity of the pyeloureteral system in the guinea-pig. Pflugers Arch. 1973; 341(3):257-70. DOI: 10.1007/BF00592794. View

13.

Thuneberg L . Interstitial cells of Cajal: intestinal pacemaker cells?. Adv Anat Embryol Cell Biol. 1982; 71:1-130. View

14.

Lang R, Tonta M, Zoltkowski B, Meeker W, Wendt I, Parkington H . Pyeloureteric peristalsis: role of atypical smooth muscle cells and interstitial cells of Cajal-like cells as pacemakers. J Physiol. 2006; 576(Pt 3):695-705. PMC: 1890417. DOI: 10.1113/jphysiol.2006.116855. View

15.

Yang X, Zhang Y, Hu J . The expression of Cajal cells at the obstruction site of congenital pelviureteric junction obstruction and quantitative image analysis. J Pediatr Surg. 2009; 44(12):2339-42. DOI: 10.1016/j.jpedsurg.2009.07.061. View