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World J Gastroenterol. Mar 21, 2011; 17(11): 1416-1426
Published online Mar 21, 2011. doi: 10.3748/wjg.v17.i11.1416
Crohn’s disease: Evidence for involvement of unregulated transcytosis in disease etio-pathogenesis
Jay Pravda
Jay Pravda, Inflammatory Disease Research Centre, PO Box 32632 West Palm Beach, Florida, FL 33420, United States
Author contributions: Pravda J performed the systematic literature review, analyzed the data, wrote the paper and originated the novel transcytotic mechanism underlying Crohn’s disease detailed herein.
Correspondence to: Jay Pravda, MD, Inflammatory Disease Research Centre, PO Box 32632 West Palm Beach, Florida, FL 33420, United States.
Telephone: +1-214-6769544 Fax: +1-888-7005813
Received: September 1, 2010
Revised: December 11, 2010
Accepted: December 18, 2010
Published online: March 21, 2011

Crohn’s disease (CD) is a chronic inflammatory bowel disease. Research has identified genetic predisposition and environmental factors as key elements in the development of the disease. However, the precise mechanism that initiates immune activation remains undefined. One pathway for luminal antigenic molecules to enter the sterile lamina propria and activate an immune response is via transcytosis. Transcytosis, although tightly regulated by the cell, has the potential for transepithelial transport of bacteria and highly antigenic luminal molecules whose uncontrolled translocation into the lamina propria can be the source of immune activation. Viewed as a whole, the evidence suggests that unregulated intestinal epithelial transcytosis is involved in the inappropriate presentation of immunogenic luminal macromolecules to the intestinal lamina propria. Thus fulfilling the role of an early pre-morbid mechanism that can result in antigenic overload of the lamina propria and initiate an immune response culminating in chronic inflammation characteristic of this disease. It is the aim of this paper to present evidence implicating enterocyte transcytosis in the early etio-pathogenesis of CD.

Keywords: Crohn’s, Transcytosis, Endocytosis