Identification of anti-endothelial cell antibodies in patients with chronic anal fissure

Background. Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the pe rianal level the interaction of immune component with endothelium could con stitute a mechanism determining ischemia and hypertonia, the presence or ab sence of circulating anti-endothelial cell antibodies (AECAs) was determine d in the serum of patients with anal fissure. Methods. The study was carried out on 30 patients: 10 with posterior chroni c anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of mt kidney tissue was used to identify, AECA in the peripheral blood. Results. The assay result was positive for AECAs in 12 patients, all with a norectal disease when compared to the control group (P =.001). The basal an al tone was higher in the AECA-positive patients than in the AECA-negative patients (P =.001). Conclusions. Only the patients with anal fissure or hemorrhoids were AECA p ositive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of autoantibodies directed agai nst the endothelial cells in the serum of these patients supports the hypot hesis that the endothelium is involved in the anal disease.