Activation of the Innate Immune System in Children With Irritable Bowel Syndrome Evidenced by Increased Fecal Human β-Defensin-2

Robert J Shulman; Sridevi Devaraj; Margaret Heitkemper

doi:10.1016/j.cgh.2020.09.034

Activation of the Innate Immune System in Children With Irritable Bowel Syndrome Evidenced by Increased Fecal Human β-Defensin-2

Clin Gastroenterol Hepatol. 2021 Oct;19(10):2121-2127. doi: 10.1016/j.cgh.2020.09.034. Epub 2020 Sep 20.

Authors

Robert J Shulman¹, Sridevi Devaraj², Margaret Heitkemper³

Affiliations

¹ Department of Pediatrics; Children's Nutrition Research Center; Texas Children's Hospital; Baylor College of Medicine, Houston, Texas. Electronic address: rshulman@bcm.edu.
² Texas Children's Hospital; Baylor College of Medicine, Houston, Texas; Department of Pathology and Immunology.
³ University of Washington, Seattle, Washington.

Abstract

Background & aims: The role of the innate immune system in functional gastrointestinal pain disorders is unclear. We investigated the role of β-defensin-2 and gut permeability in childhood irritable bowel syndrome (IBS) and functional abdominal pain (FAP) symptom generation.

Methods: Fecal β-defensin-2 (and in a subset, gut permeability) was measured in children with IBS (n = 116), FAP (n = 33), and healthy control (HC) children (n = 72). IBS and FAP patients were recruited from tertiary and primary care, and HCs were recruited from primary care.

Results: β-defensin-2 concentration was greater in children with IBS (P = .003) and FAP (P = .03) than in HCs. β-defensin-2 was greater in girls with IBS than female HCs (P = .007) and in girls with IBS vs boys with IBS (P = .036). There was no difference by sex in the FAP and HC groups. For the entire cohort, β-defensin-2 correlated with multiple pain symptoms. In the IBS group, β-defensin-2 correlated with pain interference (P = .014). No correlation with pain was found in the FAP or HC group. Gut permeability was greater in the IBS vs the FAP and HC groups (P = .038). For the entire cohort, permeability correlated with the number of pain episodes (P = .041) and interfering pain episodes (P = .049). For the entire cohort there was a correlation between β-defensin-2 and permeability (P = .003), with borderline correlation in the IBS group (P = .086). For the cohort and IBS and HC groups, the number of bowel movements was modestly inversely related to fecal β-defensin-2 concentrations.

Conclusions: Increased fecal β-defensin-2 concentration in children with IBS suggests activation of the innate immune system in some, which, along with increased gut permeability, appears related to abdominal pain symptoms. Sex is an important variable in interpreting β-defensin-2 concentration in children with IBS.

Keywords: Functional Abdominal Pain; Gastrointestinal Permeability; β-Defensin.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Abdominal Pain
Child
Feces
Female
Humans
Immune System
Irritable Bowel Syndrome*
Male
beta-Defensins*

Substances

beta-Defensins

Abstract

Publication types

MeSH terms

Substances

Grants and funding