Telocyte and Cajal cell distribution in renal pelvis, ureteropelvic junction (UPJ), and proximal ureter in normal upper urinary tract and UPJ obstruction: reappraisal of the aetiology of UPJ obstruction
Abstract
Background: Telocytes and Cajal cells have been described in human urinary tract and reproductive system in women and men. Telocytes and Cajal cells have been differentiated from other interstitial cells and were described to be an element in smooth muscle conductivity. Previous studies examined the ureteropelvic junction (UPJ) segment in patients with UPJ obstruction (UPJO) and attributed the aetiology of UPJO to the low density or absence Cajal cells and telocytes. The present work aimed at the demonstration of the presence and the density of telocytes and Cajal cells in the upper urinary tract (UUT) in cases with normal UUT and UPJO. It included UPJ segment, renal pelvis, and proximal ureter. The morphological pattern of distribution of collagen in relation to smooth muscle was investigated in normal and obstructed UUT.
Materials and methods: The study was carried out on 12 surgical specimens, 5 of them represented the normal UUT and underwent nephrectomy for oncological reasons. Seven patients underwent dismembered pyeloplasty for UPJO. Surgical specimens included renal pelvis, UPJ segment, and proximal ureter. They were subjected to standard haematoxylin and eosin stain, Gomori’s trichrome stain, immunohistochemistry with c-kit, and transmission electron microscopy.
Results: Telocytes and Cajal cells were demonstrated in the muscular layer of both normal UUT and UPJO with high density in the proximal ureter in normal UUT as well as in UPJO. The UPJ segment in normal UUT had moderate density of Cajal cells and telocytes while in UPJO the cells were scanty or absent. Renal pelvis in normal UUT showed excess density of cells while obstructed renal pelvis showed scanty Cajal cells and telocytes. Ultrastructural study showed the presence of Cajal cells, telocytes, stem cells, fibroblasts, smooth muscle cells, and collagen in different densities and distribution in normal and obstructed UUT.
Conclusions: Examination of the UPJ segment of UPJO revealed that Cajal cells and telocytes were scanty or absent, collagen to muscle ratio was high. The low density of Cajal cells and telocytes in the renal pelvis of the obstructed UUT, compared to the normal, points out to the role of the renal pelvis in the pathogenesis of UPJO.
Keywords: Cajal cellstelocytesureteropelvic junctionurinary tractinterstitial cells
References
- Cajal SR. Histologie du système nerveux de l'homme et des vertébrés. Maloine (Paris). 1909; 2: 891–942.
- Cretoiu SM, Popescu LM. Telocytes revisited. Biomol Concepts. 2014; 5(5): 353–369.
- David SG, Cebrian C, Vaughan ED, et al. c-kit and ureteral peristalsis. J Urol. 2005; 173(1): 292–295.
- Eken A, Erdogan S, Kuyucu Y, et al. Immunohistochemical and electron microscopic examination of Cajal cells in ureteropelvic junction obstruction. Can Urol Assoc J. 2013; 7(5-6): E311–E316.
- Gevaert T, De Vos R, Everaerts W, et al. Characterization of upper lamina propria interstitial cells in bladders from patients with neurogenic detrusor overactivity and bladder pain syndrome. J Cell Mol Med. 2011; 15(12): 2586–2593.
- Gevaert T, De Vos R, Van Der Aa F, et al. Identification of telocytes in the upper lamina propria of the human urinary tract. J Cell Mol Med. 2012; 16(9): 2085–2093.
- Koleda P, Apoznanski W, Wozniak Z, et al. Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction. Int Urol Nephrol. 2012; 44(1): 7–12.
- Lang RJ, Klemm MF. Interstitial cell of Cajal-like cells in the upper urinary tract. J Cell Mol Med. 2005; 9(3): 543–556.
- Maeda H, Yamagata A, Nishikawa S, et al. Requirement of c-kit for development of intestinal pacemaker system. Development. 1992; 116(2): 369–375.
- Petre N, Rusu MC, Pop F, et al. Telocytes of the mammary gland stroma. Folia Morphol. 2016; 75(2): 224–231.
- Popescu LM, Ciontea SM, Cretoiu D. Interstitial Cajal-like cells in human uterus and fallopian tube. Ann N Y Acad Sci. 2007; 1101: 139–165.
- Popescu LM, Faussone-Pellegrini MS. TELOCYTES - a case of serendipity: the winding way from Interstitial Cells of Cajal (ICC), via Interstitial Cajal-Like Cells (ICLC) to TELOCYTES. J Cell Mol Med. 2010; 14(4): 729–740.
- Qi G, Lin M, Xu M, et al. Telocytes in the human kidney cortex. J Cell Mol Med. 2012; 16(12): 3116–3122.
- Sergeant GP, Thornbury KD, McHale NG, et al. Interstitial cells of Cajal in the urethra. J Cell Mol Med. 2006; 10(2): 280–291.
- Solari V, Piotrowska AP, Puri P. Altered expression of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. J Urol. 2003; 170(6 Pt 1): 2420–2422.
- van der Aa F, Roskams T, Blyweert W, et al. Identification of kit positive cells in the human urinary tract. J Urol. 2004; 171(6 Pt 1): 2492–2496.
- Vannucchi MG, Traini C, Guasti D, et al. Telocytes subtypes in human urinary bladder. J Cell Mol Med. 2014; 18(10): 2000–2008.
- Vannucchi MG, Traini C. Interstitial cells of Cajal and telocytes in the gut: twins, related or simply neighbor cells? Biomol Concepts. 2016; 7(2): 93–102.
- Vannucchi MG. The telocytes: ten years after their introduction in the scientific literature. An update on their morphology, distribution, and potential roles in the gut. Int J Mol Sci. 2020; 21(12).
- Yamataka A, Ohshiro K, Kobayashi H, et al. Abnormal distribution of intestinal pacemaker (C-KIT-positive) cells in an infant with chronic idiopathic intestinal pseudoobstruction. J Pediatr Surg. 1998; 33(6): 859–862.
- Yang X, Zhang Y, Hu J. The expression of Cajal cells at the obstruction site of congenital pelviureteric junction obstruction and quantitative image analysis. J Pediatr Surg. 2009; 44(12): 2339–2342.
- Zheng Y, Zhu T, Lin M, et al. Telocytes in the urinary system. J Transl Med. 2012; 10: 188.
