期刊
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
卷 98, 期 6, 页码 1577-1584出版社
AMER SOC TROP MED & HYGIENE
DOI: 10.4269/ajtmh.17-0306
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资金
- Bill & Melinda Gates Foundation [OPP1066203]
- U.S. National Institute of Diabetes, Digestive, and Kidney Disease [R01DK61931, R01DK68271, R24DK099803]
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [R24DK099803, R01DK068271, R01DK061931] Funding Source: NIH RePORTER
Despite nutrition interventions, stunting thought to be secondary to underlying environmental enteropathy (EE) remains pervasive among infants residing in resource-poor countries and remains poorly characterized. From a birth cohort of 380 children, 65 malnourished infants received 12 weeks of nutritional supplementation with ready-to-use therapeutic food (RUTF). Eleven children with insufficient response to RUTF underwent upper endoscopy with duodenal biopsies, which were compared with U.S., age-matched specimens for healthy, celiac disease, non-celiac villous atrophy, non-celiac intraepithelial lymphocytosis, and graft-versus-host disease patients. Of the 11 children biopsied, EE was found in 10 (91%) with one subject with celiac disease. Morphometry demonstrated decreased villus-to-crypt (V:C) ratios in EE relative to healthy and non-celiac lymphocytosis patients. Environmental enteropathy villus volumes were significantly decreased relative to healthy controls. In EE, average CD3(+) cells per 100 epithelial cells and per 1,000 mu m(2) of lamina propria and the number of lamina propria CD20(+) B-cell aggregates were increased relative to all other groups. Our results indicate that V: C ratios are reduced in EE but are less severe than in celiac disease. Environmental enteropathy intraepithelial and lamina propria T lymphocytosis is of greater magnitude than that in celiac disease. The increases in lamina propria B and T lymphocytes suggest that non-cytolytic lymphocytic activation may be a more prominent feature of EE relative to celiac disease. These results provide new insights into shared yet distinct histological and immunological features of EE and celiac disease in children.
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