MUC2 Is a Sensitive and Specific Marker of Goblet Cell Metaplasia in the Distal Esophagus and Gastroesophageal Junction (GEJ)
M McIntire, G Soucy, TL Vaughan, RD Odze. Brigham and Women's Hospital, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA
Background: MUC2 is a mucin core glycoprotein expressed exclusively in goblet cells of the intestinal tract. A previous study suggested that MUC2 expression in non-goblet columnar cells from the esophagus represents an intermediate stage in the conversion of squamous to columnar epithelium in patients with Barrett's esophagus (BE) and is highly associated with goblet cell (GC) metaplasia. The aim of this study was to evaluate the prevalence rate and association of MUC2 positivity with GC, and with risk factors of BE, in GEJ biopsies from patients with GERD symptoms.
Design: 100 patients (50 with GC and 50 without) selected from a large group of patients (N=552) who were prospectively endoscoped and interviewed as part of a community clinic-based study of GERD patients in Washington state were immunostained with MUC2 and evaluated for the presence and degree of positivity in GC and non-goblet cells (NGC). The findings were also examined according to key clinical risk factors for BE, including gender, race, waist-to-hip ratio, smoking history, and body mass index (BMI).
Results: Overall, MUC2 staining was positive in GC from all patients (100%) and NGC from 41/100 (41%) patients. The presence of MUC2 expression in NGC correlated strongly with the presence of GC. 39/50 (78%) patients with GC were positive for MUC2 in NGC compared to only 2/50 (4%) patients without GC (p<0.0001). Both of the latter patients who showed MUC2 positivity in the absence of GC showed endoscopic evidence of esophageal columnar metaplasia. In a sub-analysis, both GC, and MUC2 staining in NGC, correlated with endoscopic evidence of columnar metaplasia (p=0.05, p=0.02, respectively). Interestingly, the prevalence rate of MUC2 staining was significantly more common in patients ≥ 50 years of age (p=0.0003), Caucasians (p=<0.0001), those with a BMI of > 25 (p=0.00006), and with increased frequency of heartburn (≥ weekly) (p=0.0003), all of which have been previously shown to be risk factors for BE.
Conclusions: MUC2 in NGC is highly predictive of GC metaplasia in the distal esophagus and GEJ. MUC2 staining in GEJ biopsies is associated with known risk factors for BE and with endoscopic evidence of BE. These results confirm that MUC2 expression in NGC represents an intermediate step in the development of GC metaplasia in the esophagus and GEJ region.
Monday, March 22, 2010 1:00 PM
Poster Session II # 68, Monday Afternoon