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World J Gastrointest Surg. Dec 27, 2021; 13(12): 1536-1549
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1536
Role of mesenteric component in Crohn’s disease: A friend or foe?
Yi Yin, Zhen-Xing Zhu, Zhun Li, Yu-Sheng Chen, Wei-Ming Zhu
Yi Yin, Zhen-Xing Zhu, Zhun Li, Yu-Sheng Chen, Wei-Ming Zhu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Yin Y and Zhu ZX contributed equally to this work; Yin Y and Zhu ZX designed and wrote the final version of the manuscript; Li Z and Chen YS were critical for the acquisition of data and drafting the manuscript; Zhu WM made critical revisions to the design and gave final approval for the article to be submitted.
Conflict-of-interest statement: All authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Ming Zhu, MD, PhD, Chief Doctor, Professor, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. drweimingzhu@126.com
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: July 29, 2021
Revised: August 1, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 27, 2021
Abstract

Crohn’s disease (CD) is a complex and relapsing gastrointestinal disease with mesenteric alterations. The mesenteric neural, vascular, and endocrine systems actively take part in the gut dysbiosis-adaptive immunity-mesentery-body axis, and this axis has been proven to be bidirectional. The abnormalities of morphology and function of the mesenteric component are associated with intestinal inflammation and disease progress of CD via responses to afferent signals, neuropeptides, lymphatic drainage, adipokines, and functional cytokines. The hypertrophy of mesenteric adipose tissue plays important roles in the pathogenesis of CD by secreting large amounts of adipokines and representing a rich source of proinflammatory or profibrotic cytokines. The vascular alteration, including angiogenesis and lymphangiogenesis, is concomitant in the disease course of CD. Of note, the enlarged and obstructed lymphatic vessels, which have been described in CD patients, are likely related to the early onset submucosa edema and being a cause of CD. The function of mesenteric lymphatics is influenced by endocrine of mesenteric nerves and adipocytes. Meanwhile, the structure of the mesenteric lymphatic vessels in hypertrophic mesenteric adipose tissue is mispatterned and ruptured, which can lead to lymph leakage. Leaky lymph factors can in turn stimulate adipose tissue to proliferate and effectively elicit an immune response. The identification of the role of mesentery and the crosstalk between mesenteric tissues in intestinal inflammation may shed light on understanding the underlying mechanism of CD and help explore new therapeutic targets.

Keywords: Crohn’s disease, Mesenteric nerves, Angiogenesis, Lymphatic drainage, Mesenteric adipose tissue

Core Tip: Crohn’s disease (CD) is a complex autoimmune disease with increasing incidence worldwide, especially in Asian countries in recent years. There has been excellent progress in understanding the role of the mesentery in the pathogenesis and disease progress of CD. The crosstalk between components and intestinal inflammation has aroused many researchers’ interests. Herein, we will discuss the basic function and the alteration under inflammatory state of mesenteric nerves, blood vessels, lymphatics, and fat mass. Existing therapeutic strategies associated with mesentery components will also be summarized.