Pyloric metaplasia, pseudopyloric metaplasia, ulcer-associated cell lineage and spasmolytic polypeptide-expressing metaplasia: reparative lineages in the gastrointestinal mucosa

Abstract

The gastrointestinal mucosae provide a critical barrier between the external and internal milieu. Thus, damage to the mucosa requires an immediate response to provide appropriate wound closure and healing. Metaplastic lineages with phenotypes similar to the mucous glands of the distal stomach or Brunner's glands have been associated with various injurious scenarios in the stomach, small bowel, and colon. These lineages have been assigned various names including pyloric metaplasia, pseudopyloric metaplasia, ulcer-associated cell lineage (UACL), and spasmolytic polypeptide-expressing metaplasia (SPEM). A re-examination of the literature on these various forms of mucous cell metaplasia suggests that pyloric-type mucosal gland lineages may provide a ubiquitous response to mucosal injury throughout the gastrointestinal tract as well as in the pancreas, esophagus, and other mucosal surfaces. While the cellular origin of these putative reparative lineages likely varies in different regions of the gut, their final phenotypes may converge on a pyloric-type gland dedicated to mucous secretion. In addition to their healing properties in the setting of acute injury, these pyloric-type lineages may also represent precursors to neoplastic transitions in the face of chronic inflammatory influences. Further investigations are needed to determine how discrete molecular profiles relate to the origin and function of pyloric-type metaplasias previously described by histological characteristics in multiple epithelial mucosal systems in the setting of acute and chronic damage. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Keywords: SPEM; gastrointestinal mucosa; mucosal injury; mucous glands; pseudopyloric metaplasia; pyloric metaplasia; spasmolytic polypeptide-expressing metaplasia; ulcer-associated cell lineage; ulscer.

Figure 1

A generalized pattern for the induction of pyloric phenotype reparative metaplasias. Injury to the lining of gastrointestinal mucosae by various acute or chronic maladies leads to the evolution of metaplastic glands which recapitulate the structure of mucous-secreting glands of the distal stomach with TFF2/Muc6-expressing mucous cells at the bases and TFF1/Muc5AC-expressing cells towards the lumen. These reparative glands can be identified histologically and immunohistologically by various names, but all share a common pyloric gland phenotype.