Abstract：
Achalasia is an esophageal motility disorder with an unknown etiology. We aimed to determine the pathogenesis of achalasia by studying alterations in esophageal smooth muscle contraction and the associated inflammatory response, and evaluate the role of esophageal microbiota in achalasia development.
We analyzed esophageal mucosa and lower esophageal sphincter (LES) samples, obtained from patients with type II achalasia who underwent peroral endoscopic myotomy. Esophageal conditioned media obtained from patients were transferred into the mouse esophagus to determine whether the esophageal intraluminal environment is associated with achalasia.
Approximately 30% of 20-kDa myosin light chains (LC20) was phosphorylated in LES from the control group under resting and stimulated conditions, whereas less than 10% of LC20 phosphorylation was detected in achalasia under all conditions. The hypophosphorylation of LC20 in achalasia was associated with the downregulation of the myosin phosphatase-inhibitor protein CPI-17. Th17-related cytokines, including IL-17A, IL-17F, IL-22, and IL-23A, were significantly upregulated in achalasia. α-Diversity index of esophageal microbiota and the proportion of several microbes, including Actinomyces and Dialister, increased in achalasia. Actinomyces levels positively correlated with IL-23A levels, whereas Dialister levels were positively associated with IL-17A, IL-17F, and IL-22 levels. Esophageal IL-17F levels increased in mice after oral administration of the conditioned media.
In LES of patients with achalasia, hypophosphorylation of LC20, a possible cause of impaired contractility, was associated with CPI-17 downregulation and an increased Th17-related immune response. The esophageal intraluminal environment, represented by the esophageal microbiota, could be associated with the development and exacerbation of achalasia.
We analyzed esophageal mucosa and lower esophageal sphincter (LES) samples, obtained from patients with type II achalasia who underwent peroral endoscopic myotomy. Esophageal conditioned media obtained from patients were transferred into the mouse esophagus to determine whether the esophageal intraluminal environment is associated with achalasia.
Approximately 30% of 20-kDa myosin light chains (LC20) was phosphorylated in LES from the control group under resting and stimulated conditions, whereas less than 10% of LC20 phosphorylation was detected in achalasia under all conditions. The hypophosphorylation of LC20 in achalasia was associated with the downregulation of the myosin phosphatase-inhibitor protein CPI-17. Th17-related cytokines, including IL-17A, IL-17F, IL-22, and IL-23A, were significantly upregulated in achalasia. α-Diversity index of esophageal microbiota and the proportion of several microbes, including Actinomyces and Dialister, increased in achalasia. Actinomyces levels positively correlated with IL-23A levels, whereas Dialister levels were positively associated with IL-17A, IL-17F, and IL-22 levels. Esophageal IL-17F levels increased in mice after oral administration of the conditioned media.
In LES of patients with achalasia, hypophosphorylation of LC20, a possible cause of impaired contractility, was associated with CPI-17 downregulation and an increased Th17-related immune response. The esophageal intraluminal environment, represented by the esophageal microbiota, could be associated with the development and exacerbation of achalasia.
摘要：
背景：贲门失弛缓症是一种病因不明的食管运动障碍。我们旨在通过研究食管平滑肌收缩的改变和相关的炎症反应来确定门失弛缓症的发病机制。并评价食管微生物在贲门失弛缓症发生发展中的作用。
方法：我们分析了食管粘膜和食管下括约肌（LES）样本，从接受经口内镜肌切开术的II型门失弛缓症患者中获得。将从患者获得的食管条件培养基转移到小鼠食管中以确定食管腔内环境是否与贲门失弛缓症相关。
结果：在静息和刺激条件下，来自对照组的LES中约有30％的20kDa肌球蛋白轻链（LC20）被磷酸化，而在所有条件下，在贲门失弛缓症中均检测到不到10%的LC20磷酸化。贲门失弛缓症中LC20的低磷酸化与肌球蛋白磷酸酶抑制剂蛋白CPI-17的下调有关。Th17相关细胞因子，包括IL-17A,IL-17F,IL-22和IL-23A,在贲门失弛缓症中显著上调。α-食管微生物多样性指数和几种微生物比例，包括放线菌和Dialister,贲门失弛缓症增加。放线菌水平与IL-23A水平呈正相关，而Dialister水平与IL-17A呈正相关，IL-17F,IL-22水平。口服条件培养基后，小鼠食管IL-17F水平升高。
结论：在LES的门失弛缓症患者中，LC20的低磷酸化，可能是收缩性受损的原因，与CPI-17下调和Th17相关免疫反应增加有关。食管腔内环境,以食道微生物群为代表，可能与贲门失弛缓症的发展和加剧有关。
方法：我们分析了食管粘膜和食管下括约肌（LES）样本，从接受经口内镜肌切开术的II型门失弛缓症患者中获得。将从患者获得的食管条件培养基转移到小鼠食管中以确定食管腔内环境是否与贲门失弛缓症相关。
结果：在静息和刺激条件下，来自对照组的LES中约有30％的20kDa肌球蛋白轻链（LC20）被磷酸化，而在所有条件下，在贲门失弛缓症中均检测到不到10%的LC20磷酸化。贲门失弛缓症中LC20的低磷酸化与肌球蛋白磷酸酶抑制剂蛋白CPI-17的下调有关。Th17相关细胞因子，包括IL-17A,IL-17F,IL-22和IL-23A,在贲门失弛缓症中显著上调。α-食管微生物多样性指数和几种微生物比例，包括放线菌和Dialister,贲门失弛缓症增加。放线菌水平与IL-23A水平呈正相关，而Dialister水平与IL-17A呈正相关，IL-17F,IL-22水平。口服条件培养基后，小鼠食管IL-17F水平升高。
结论：在LES的门失弛缓症患者中，LC20的低磷酸化，可能是收缩性受损的原因，与CPI-17下调和Th17相关免疫反应增加有关。食管腔内环境,以食道微生物群为代表，可能与贲门失弛缓症的发展和加剧有关。
