Decreased Expression of Prox1 Is Associated With Postoperative Recurrence in Crohn's Disease

Background: Prox1 is a transcription factor necessary for lymphangiogenesis and lymphatic function. The aim of the study was to assess the correlation between the expression of Prox1 and postoperative recurrence in Crohn's disease [CD]. Methods: Forty CD patients who underwent ileo-colonic resection were included. Expression levels of Prox1 and D2-40 were detected using immunohistochemistry. Expression levels of Prox1, VEGFR3, and VEGFC protein were also detected in fresh CD specimens using western blotting and quantitative polymerase chain reaction [Q-PCR]. Endoscopic recurrence was used as the endpoint. Patients comprised two groups: endoscopic recurrence [Group R+] and no endoscopic recurrence [Group R-]. Results: Prox1 protein expression was significantly higher in CD than in normal tissues [p < 0.05], as detected using both immunohistochemistry and western blotting. Analysis of inter-relationships revealed significant correlation between Prox1 expression and lymphatic vessel density [p < 0.001, r = 0.823]. There was also significant correlation between Prox1 expression and the visceral fat area [VFA] [p = 0.002, r = -0.469]. The Group R-patients had significantly higher Prox1 expression than the Group R+ patients [21.08 +/- 1.61 versus 15.64 +/- 1.17, p = 0.011]. Also, the lymphatic vessel density value was lower in Group R+ than in Group R-patients [6.02 +/- 0.39 versus 8.13 +/- 0.59, p = 0.004]. Moreover, there was a significant difference in the VFA between Group R-and Group R+ patients [64.43 +/- 7.76 versus 90.44 +/- 6.11, p = 0.016]. In addition to Prox1, VEGFC/VEGFR3 was found to increase, which was further confirmed using Q-PCR. Conclusions: Prox1 expression could be useful as a protective factor against recurrence in CD patients. The therapeutic role of Prox1 may lead to improved treatments.