TGF-β1 and IGF-1 and anastomotic recurrence of Crohn's disease after ileo-colonic resection

Marco Scarpa, Marina Bortolami, Susan L. Morgan, Andromachi Kotsafti, Cesare Ruffolo, Renata D'Incà, Eugenia Bertin, Lino Polese, Davide F. D'Amico, Giacomo C. Sturniolo, Imerio Angriman

Research output: Contribution to journalArticlepeer-review


Background: After bowel resection, Crohn's disease (CD) recurs frequently in the site of the anastomosis. Alteration of normal healing processes may play a role in this phenomenon. Transforming growth factor beta (TGF-β) and insulin-like growth factor (IGF-1) are involved in wound healing mechanisms with pro-fibrogenic properties. The aim of this study was to assess the expression of TGF-β1 and insulin-like growth factor 1 (IGF-1) in the different zones of the bowel wall to understand why side-to-side anastomosis are associated to a lower recurrence rate compared to end-to-end ones. Patients and Methods: Seventeen patients affected by CD who underwent ileo-colonic resection from 2004 to 2005 were enrolled in this study. Full-thickness tissue samples were obtained from the mesenteric, the lateral, and the anti-mesenteric sides of the macroscopically diseased and healthy ileum for each patient. TGF-β1 and IGF-1 messenger RNAs (mRNAs) were quantified by real-time polymerase chain reaction. Myeloperoxidase activity and histological disease activity were assessed to quantify the ileal inflammation. Vimentin, desmin, and α-smooth muscle actin were stained with immunohistochemistry to assess the fibroblast, smooth muscle cell, and myofibroblasts populations. Comparisons and correlations were carried out with nonparametric tests. Results: In diseased ileum, TGF-β1 mRNA transcripts in the antimesenteric side were significantly lower than those of the mesenteric side (p = 0.05), and a significant correlation between TGFβ-1 levels in diseased bowel and the sampling site was observed (τ = 0.36, p = 0.03). On the contrary, neither the IGF-1 mRNA transcripts nor the distribution of fibroblast, smooth muscle cell, and myofibroblasts populations showed any relation with the sampling site. Conclusion: TGF-β1 mRNA expression was lower in the anti-mesenteric side of the diseased ileum, and this was consistent with the success of side-to-side anastomosis in preventing CD recurrence. Since high expression of TGF-β1 was associated to early recurrence, it seems rationale to construct the anastomosis on the anti-mesenteric side of the bowel.

Original languageEnglish
Pages (from-to)1981-1990
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number11
Publication statusPublished - Nov 2008


  • Anastomosis
  • Crohn's disease
  • IGF-1
  • Recurrence
  • TGF-β1

ASJC Scopus subject areas

  • Medicine(all)
  • Gastroenterology
  • Surgery


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