Interstitial cells of Cajal in health and disease: A comparative review in humans and animals

ICCs in motility disorders

Authors

  • Khulood Ayad Majeed Department of Basic Medical Sciences, College of Dentistry, University of Kirkuk, Iraq https://orcid.org/0009-0007-3732-2934
  • Raghad Ayad Majeed Department of Basic Medical Sciences, College of Dentistry, University of Kirkuk, Iraq; Department of Biology, College of Education for Pure Sciences, University of Kirkuk, Iraq https://orcid.org/0009-0007-7519-876X
  • Taisir Khalil Ibrahim Department of Biology, College of Science, Tikrit University, Iraq

DOI:

https://doi.org/10.62310/liab.v5i1.252

Keywords:

ICCs, Motility disorders, PDGFRα cells, Neuromodulation, Signal transduction, Pacemaker

Abstract

Interstitial Cells of Cajal (ICCs) are critical modulators of gastrointestinal motility due to their dual roles of initiating slow waves and providing the interlinking connections to enteric neurotransmission within the syncytium known as the SIP, consisting of smooth muscle cells, ICCs, and platelet derived growth factor- α (PDGFRα+) cells. Experimental and clinical evidence consistently demonstrates that ICC loss or dysfunction, whether due to quantitative depletion or functional impairment, is strongly associated with motility disorders such as gastroparesis, chronic constipation, and pseudo-obstruction, as well as veterinary conditions including equine colic and congenital disorders in young animals. Advances in diagnostic tools, including ANO1 immunostaining, live-cell calcium imaging, and genetic analysis, have significantly improved our ability to characterise ICC networks. Therapeutically, while current management relies mainly on prokinetic drugs and supportive care, future strategies such as stem cell–based regenerative therapies, organoid technology, and molecular targeting of ANO1 channels and c-Kit signalling pathways offer promising avenues for restoring ICC function and improving outcomes in both veterinary and human medicine. This review provides an overview of ICC pathophysiology and highlights recent progress in diagnostic and therapeutic developments, with particular emphasis on comparative evidence across human and veterinary medicine to identify shared mechanisms and translational opportunities.

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References

Al-Ahmadi A, Mohammed RA, Atteya M, Al-Matrafi TA, Alfayez MA. (2023). Anoctamin 1 and c-Kit immunohistochemical study of interstitial cells of Cajal in the muscularis externa of human gastrointestinal tract. Folia Morphologica 82(1): 147–157. https://doi.org/10.5603/FM.a2021.0138

Baker SA, Drumm BT, Saur D, Hennig GW, Ward SM, Sanders KM. (2016). Spontaneous Ca(2+) transients in interstitial cells of Cajal located within the deep muscular plexus of the murine small intestine. The Journal of Physiology 594(12): 3317–3338. https://doi.org/10.1113/JP271699

Baker SA, Hwang SJ, Blair PJ, Sireika C, Wei L, Ro S, Ward SM, Sanders KM. (2021). Ca2+ transients in ICC-MY define the basis for the dominance of the corpus in gastric pacemaking. Cell Calcium 99: 102472. https://doi.org/10.1016/j.ceca.2021.102472

Beckett EA, Sanders KM, Ward SM. (2017). Inhibitory responses mediated by vagal nerve stimulation are diminished in stomachs of mice with reduced intramuscular interstitial cells of Cajal. Scientific Reports 7: 44759. https://doi.org/10.1038/srep44759

Burns AJ. (2007). Disorders of interstitial cells of Cajal. Journal of Pediatric Gastroenterology and Nutrition 45(2): S103–S106. https://doi.org/10.1097/MPG.0b013e31812e65e0

Chang L, Chey WD, Imdad A, Almario CV, Bharucha AE, Diem S, Greer KB, Hanson B, Harris LA, Ko C, Murad MH, Patel A, Shah ED, Lembo AJ, Sultan S. (2023). American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. Gastroenterology 164(7): 1086–1106. https://doi.org/10.1053/j.gastro.2023.03.214

Chen ZH, Zhang YC, Jiang WF, Yang C, Zou GM, Kong Y, Cai W. (2014) Characterization of Interstitial Cajal Progenitors Cells and Their Changes in Hirschsprung’s Disease. PLOS One 9(1): e86100. https://doi.org/10.1371/journal.pone.0086100

Choi EL, Taheri N, Tan E, Matsumoto K, Hayashi Y. (2023). The Crucial Role of the Interstitial Cells of Cajal in Neurointestinal Diseases. Biomolecules 13(9): 1358. https://doi.org/10.3390/biom13091358

Drumm, B. T., Hennig, G. W., Battersby MJ, Cunningham EK, Sung TS, Ward SM, Sanders KM, Baker SA. (2017). Clustering of Ca2+ transients in interstitial cells of Cajal defines slow wave duration. The Journal of General Physiology 149(7): 703–725. https://doi.org/10.1085/jgp.201711771

Drumm BT, Hwang SJ, Baker SA, Ward SM, Sanders KM. (2019). Ca2+ signalling behaviours of intramuscular interstitial cells of Cajal in the murine colon. The Journal of Physiology 597(14): 3587–3617. https://doi.org/10.1113/JP278036

Fintl C, Hudson NP. (2010). The interstitial cells of Cajal of the equine gastrointestinal tract: what we know so far. Equine Veterinary Journal 42(4): 372–377. https://doi.org/10.1111/j.2042-3306.2010.00073.x

Fintl C, Hudson NP, Mayhew IG, Edwards GB, Proudman CJ, Pearson GT. (2004). Interstitial cells of Cajal (ICC) in equine colic: an immunohistochemical study of horses with obstructive disorders of the small and large intestines. Equine Veterinary Journal 36(6): 474–479. https://doi.org/10.2746/0425164044877314

Fintl C, Lindberg R, McL Press C. (2020). Myenteric networks of interstitial cells of Cajal are reduced in horses with inflammatory bowel disease. Equine Veterinary Journal 52(2): 298–304. https://doi.org/10.1111/evj.13160

Fintl C, Pearson GT, Mayhew IG, Stewart Lowden C, Hopwood PA, Palgrave CJ, Proudman CJ, Barrie Edwards G, Taylor SE, Hudson NP. (2010). Comparative analysis of c-kit gene expression and c-Kit immunoreactivity in horses with and without obstructive intestinal disease. The Veterinary Journal 186(1): 64–69. https://doi.org/10.1016/j.tvjl.2009.07.015

Foong D, Zhou J, Zarrouk A, Ho V, O'Connor MD. (2020). Understanding the Biology of Human Interstitial Cells of Cajal in Gastrointestinal Motility. International Journal of Molecular Sciences 21(12): 4540. https://doi.org/10.3390/ijms21124540

Friedmacher F, Rolle U. (2023). Interstitial cells of Cajal: clinical relevance in pediatric gastrointestinal motility disorders. Pediatric Surgery International 39(1): 188. https://doi.org/10.1007/s00383-023-05467-1

Galiazzo G. (2020). Characterization of Cannabinoid Receptors in the Peripheral Nervous System and in the Gastrointestinal Tract of Mammals of Veterinary Interest. University of Bologna.

Hawes D, Shi SR, Dabbs DJ, Taylor CR, Cote RJ. (2009). Immunohistochemistry. Modern Surgical Pathology 48–70. https://doi.org/10.1016/B978-1-4160-3966-2.00016-3

Hirst GD, Ward SM. (2003). Interstitial cells: involvement in rhythmicity and neural control of gut smooth muscle. The Journal of Physiology 550(2): 337–346. https://doi.org/10.1113/jphysiol.2003.043299

Hudson N, Mayhew I, Pearson G. (2001). A reduction in interstitial cells of Cajal in horses with equine dysautonomia (grass sickness). Autonomic Neuroscience: Basic & Clinical 92(1): 37–44. https://doi.org/10.1016/S1566-0702(01)00316-2

Huizinga JD, Chen JH. (2014). Interstitial cells of Cajal: update on basic and clinical science. Current Gastroenterology Reports 16(1): 363. https://doi.org/10.1007/s11894-013-0363-z

Huizinga JD, Hussain A, Chen JH. (2021). Interstitial cells of Cajal and human colon motility in health and disease. American journal of physiology. Gastrointestinal and Liver Physiology 321(5): G552–G575. https://doi.org/10.1152/ajpgi.00264.2021

Huizinga JD, Hussain A, Chen JH. (2022). Generation of Gut Motor Patterns Through Interactions Between Interstitial Cells of Cajal and the Intrinsic and Extrinsic Autonomic Nervous Systems. Advances in Experimental Medicine and Biology 1383: 205–212. https://doi.org/10.1007/978-3-031-05843-1_19

Huizinga JD, Thuneberg L, Vanderwinden JM, Rumessen JJ. (1997). Interstitial cells of Cajal as targets for pharmacological intervention in gastrointestinal motor disorders. Trends in Pharmacological Sciences 18(10): 393–403. https://doi.org/10.1016/s0165-6147(97)01108-5

Huizinga JD, Zarate N, Farrugia G. (2009). Physiology, injury, and recovery of interstitial cells of Cajal: basic and clinical science. Gastroenterology 137(5): 1548–1556. https://doi.org/10.1053/j.gastro.2009.09.023

Hwang SJ, Drumm BT, Kim MK, Lyu JH, Baker S, Sanders KM, Ward SM. (2022). Calcium Transients in Intramuscular Interstitial Cells of Cajal of the Murine Gastric Fundus and Their Regulation by Neuroeffector Transmission. The Journal of Physiology 600(20): 4439–4463. https://doi.org/10.1113/jp282876

Hwang SJ, Kwon JG, Beckett EAH, Kim M, Herbert T, Sanders KM, Ward SM. (2025). Functional roles of interstitial cells of Cajal in the GI tract of rats. American Journal of Physiology-Gastrointestinal and Liver Physiology 328(6): G677–G695. https://doi.org/10.1152/ajpgi.00036.2025

Iino S, Horiguchi K, Horiguchi S. (2020). c-Kit-stem cell factor signal-independent development of interstitial cells of Cajal in murine small intestine. Cell and Tissue Research 379(1): 121–129. https://doi.org/10.1007/s00441-019-03120-9

Jackman L, Arpe L, Thapar N, Rybak A, Borrelli O. (2024). Nutritional Management of Pediatric Gastrointestinal Motility Disorders. Nutrients 16(17): 2955. https://doi.org/10.3390/nu16172955

Kaji N, Nakayama S, Horiguchi K, Iino S, Ozaki H, Hori M. (2018). Disruption of the pacemaker activity of interstitial cells of Cajal via nitric oxide contributes to postoperative ileus. Neurogastroenterology and Motility 30(8): e13334. https://doi.org/10.1111/nmo.13334

Kishi K, Kamizaki M, Kaji N, Iino S, Hori M. (2020). A Close Relationship Between Networks of Interstitial Cells of Cajal and Gastrointestinal Transit In Vivo. Frontiers in Pharmacology 11: 587453. https://doi.org/10.3389/fphar.2020.587453

Klein S, Seidler B, Kettenberger A, Sibaev A, Rohn M, Feil R, Allescher HD, Vanderwinden JM, Hofmann F, Schemann M, Rad R, Storr MA, Schmid RM, Schneider G, Saur D. (2013). Interstitial cells of Cajal integrate excitatory and inhibitory neurotransmission with intestinal slow-wave activity. Nature Communications 4: 1630. https://doi.org/10.1038/ncomms2626

Koenig J, Cote N. (2006). Equine Gastrointestinal Motility-Ileus and Pharmacological Modification. The Canadian Veterinary Journal 47(6): 551–559. https://pmc.ncbi.nlm.nih.gov/articles/PMC1461410/

Komuro T. (2006). Structure and organization of interstitial cells of Cajal in the gastrointestinal tract. The Journal of Physiology 576(3): 653–658. https://doi.org/10.1113/jphysiol.2006.116624

Laus F, Fratini M, Paggi E, Faillace V, Spaterna A, Tesei B, Fettucciari K, Bassotti G. (2017). Effects of Single-Dose Prucalopride on Intestinal Hypomotility in Horses: Preliminary Observations. Scientific Reports 7: 41526. https://doi.org/10.1038/srep41526

Li L, Zou C, Zhou Z, Wang X, Yu X. (2019). Phenotypic changes of interstitial cells of Cajal after intestinal obstruction in rat model. Brazilian Journal of Medical and Biological Research 52(10): e8343. https://doi.org/10.1590/1414-431X20198343

Liang Y, Tarique I, Vistro WA, Liu Y, Wang Z, Haseeb A, Gandahi NS, Iqbal A, Wang S, An T, Yang H, Chen Q, Yang P. (2019). Age-associated changes of the intrinsic nervous system in relation with interstitial cells in the pre-weaning goat rumen. Aging 11(13): 4641–4653. https://doi.org/10.18632/aging.102076

Majeed KA, Jaafar HA, Jarullah HA. (2024a). Histological and histochemical study of effect of dietary fibre in motility of stomach in male mice. JPMA. The Journal of the Pakistan Medical Association 74(10): S437–S441. https://doi.org/10.47391/JPMA-BAGH-16-98

Majeed KA, Jaafar HA, Rasol HM. (2024b). Effects of protein diet on expression of Anoctamin1 of Cajal cell in the nervous plexus of the stomach in male mice. JPMA. The Journal of the Pakistan Medical Association 74(10): S432–S436. https://doi.org/10.47391/JPMA-BAGH-16-97

Márquez SG, Galotta JM, Gálvez GA, Portiansky EL, Barbeito CG. (2014). Presence of c-kit positive cells in fetal and adult bovine fore stomachs. Biotechnic & Histochemistry 89(8): 591–601. https://doi.org/10.3109/10520295.2014.919023

Mikkelsen HB. (2010). Interstitial cells of Cajal, macrophages and mast cells in the gut musculature: morphology, distribution, spatial and possible functional interactions. Journal of Cellular and Molecular Medicine 14(4): 818–832. https://doi.org/10.1111/j.1582-4934.2010.01025.x

Mostafa RM, Moustafa YM, Hamdy H. (2010). Interstitial cells of Cajal, the Maestro in health and disease. World Journal of Gastroenterology 16(26): 3239–3248. https://doi.org/10.3748/wjg.v16.i26.3239

Okamura K, Sasaki N, Yamada M, Yamada H, Inokuma H. (2009). Effects of mosapride citrate, metoclopramide hydrochloride, lidocaine hydrochloride, and cisapride citrate on equine gastric emptying, small intestinal and caecal motility. Research in Veterinary Science 86(2): 302–308. https://doi.org/10.1016/j.rvsc.2008.07.008

Pavone S, Gialletti R, Pepe M, Onofri A, Mandara MT. (2012). Histological and immunohistochemical studies of changes in myenteric plexuses and in interstitial cells of Cajal associated with equine colic. Research in Veterinary Science 93(1): 350–359. https://doi.org/10.1016/j.rvsc.2011.07.019

Pirie RS, Jago RC, Hudson NP. (2014). Equine grass sickness. Equine Veterinary Journal 46(5): 545–553. https://doi.org/10.1111/evj.12254

Porcher C, Baldo M, Henry M, Orsoni P, Julé Y, Ward SM. (2002). Deficiency of interstitial cells of Cajal in the small intestine of patients with Crohn's disease. The American Journal of Gastroenterology 97(1): 118–125. https://doi.org/10.1111/j.1572-0241.2002.05430.x

Ro S, Park C, Jin J, Zheng H, Blair PJ, Redelman D, Ward SM, Yan W, Sanders KM. (2010). A model to study the phenotypic changes of interstitial cells of Cajal in gastrointestinal diseases. Gastroenterology 138(3): 1068–1078. https://doi.org/10.1053/j.gastro.2009.11.007

Rolle U, Piaseczna-Piotrowska A, Puri P. (2007). Interstitial cells of Cajal in the normal gut and in intestinal motility disorders of childhood. Pediatric Surgery International 23(12): 1139–1152. https://doi.org/10.1007/s00383-007-2022-7

Rybak A, Sethuraman A, Nikaki K, Koeglmeier J, Lindley K, Borrelli O. (2020). Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure. Nutrients 12(11): 3536. https://doi.org/10.3390/nu12113536

Sanders KM. (2019). Spontaneous Electrical Activity and Rhythmicity in Gastrointestinal Smooth Muscles. Advances in Experimental Medicine and Biology 1124: 3–46. https://doi.org/10.1007/978-981-13-5895-1_1

Sanders KM, Drumm BT, Cobine CA, Baker SA. (2024). Ca2+ dynamics in interstitial cells: foundational mechanisms for the motor patterns in the gastrointestinal tract. Physiological Reviews 104(1): 329–398. https://doi.org/10.1152/physrev.00036.2022

Sanders KM, Ordög T, Ward SM. (2002). Physiology and Pathophysiology of the Interstitial Cells of Cajal: From Bench to Bedside. IV. Genetic and Animal Models of GI Motility Disorders Caused by Loss of Interstitial Cells of Cajal. American Journal of Physiology. Gastrointestinal and Liver Physiology 282(5): G747–G756. https://doi.org/10.1152/ajpgi.00362.2001

Sanders KM, Santana LF, Baker SA. (2023). Interstitial cells of Cajal - pacemakers of the gastrointestinal tract. The Journal of Physiology 10.1113/JP284745. https://doi.org/10.1113/JP284745

Sanders KM, Ward SM, Koh SD. (2014). Interstitial cells: regulators of smooth muscle function. Physiological Reviews 94(3): 859–907. https://doi.org/10.1152/physrev.00037.2013

Sarna SK. (2008). Are interstitial cells of Cajal plurifunction cells in the gut?. American Journal of Physiology. Gastrointestinal and Liver Physiology 294(2): G372–G390. https://doi.org/10.1152/ajpgi.00344.2007

Sweet T, Abraham CM, Rich A. (2024). Origin and Development of Interstitial Cells of Cajal. The International Journal of Developmental Biology 68(3): 93–102. https://doi.org/10.1387/ijdb.240057ar

Varghese C, Pasricha PJ, Abell TL, Parkman HP, Andrews CN, Keszthelyi D, Gharibans AA, Farrugia G, O'Grady G. (2025). Spectrum of Interstitial Cell of Cajal Deficits in Chronic Gastroduodenal Disorders: Systematic Review and Meta-Analysis. The American Journal of Gastroenterology 10.14309/ajg.0000000000003646. https://doi.org/10.14309/ajg.0000000000003646

Wang L, Liang Y, Chen Q, Ahmed N, Wang F, Hu B, Yang P. (2018). Identification and Distribution of the Interstitial Cells of Cajal in the Abomasum of Goats. Cell Transplantation 27(2): 335–344. https://doi.org/10.1177/0963689717722561

Wang XY, Liu LW, Diamant NE, Huizinga JD. (2007). Unique distribution of interstitial cells of Cajal in the feline pylorus. Cell and Tissue Research 329(1): 13–24. https://doi.org/10.1007/s00441-007-0404-8

Ward SM, Sanders KM. (2001). Physiology and pathophysiology of the interstitial cell of Cajal: from bench to bedside. I. Functional development and plasticity of interstitial cells of Cajal networks. American Journal of Physiology. Gastrointestinal and Liver Physiology 281(3): G602–G611. https://doi.org/10.1152/ajpgi.2001.281.3.G602

Ward SM, Sanders KM. (2006). Involvement of intramuscular interstitial cells of Cajal in neuroeffector transmission in the gastrointestinal tract. The Journal of Physiology 576(3): 675–682. https://doi.org/10.1113/jphysiol.2006.117390

Wu CC, Lin YM, Gao J, Winston JH, Cheng LK, Shi XZ. (2013). Are interstitial cells of Cajal involved in mechanical stress-induced gene expression and impairment of smooth muscle contractility in bowel obstruction?. PloS One 8(9): e76222. https://doi.org/10.1371/journal.pone.0076222

Yoshimaru K, Matsuura T, Uchida Y, Sonoda S, Maeda S, Kajihara K, Kawano Y, Shirai T, Toriigahara Y, Kalim AS, Zhang XY, Takahashi Y, Kawakubo N, Nagata K, Yamaza H, Yamaza T, Taguchi T, Tajiri T. (2024). Cutting-edge regenerative therapy for Hirschsprung disease and its allied disorders. Surgery Today 54(9): 977–994. https://doi.org/10.1007/s00595-023-02741-6

Zhang L, Song Z, Huang X, Jiang B, Shen Y, Li X, Jiang X, Wan J, Xu Q, Liu Q, He Z, Zhao B, Li J, Yan J, Zhang Z, Wang Z. (2025). Research progress on the regulation of interstitial cell of Cajal autophagy and apoptosis crosstalk by traditional Chinese medicine in gastrointestinal motility disorders. Journal of Ethnopharmacology 351: 120128. https://doi.org/10.1016/j.jep.2025.120128

Zhou J, O'Connor MD, Ho V. (2017). The Potential for Gut Organoid Derived Interstitial Cells of Cajal in Replacement Therapy. International Journal of Molecular Sciences 18(10): 2059. https://doi.org/10.3390/ijms18102059

Zhu MH, Sung TS, O'Driscoll K, Koh SD, Sanders KM. (2015). Intracellular Ca(2+) release from endoplasmic reticulum regulates slow wave currents and pacemaker activity of interstitial cells of Cajal. American journal of physiology. Cell Physiology 308(8): C608–C620. https://doi.org/10.1152/ajpcell.00360.2014

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Published

16-11-2025

How to Cite

Majeed, K. A., Majeed, R. A., & Ibrahim, T. K. (2025). Interstitial cells of Cajal in health and disease: A comparative review in humans and animals: ICCs in motility disorders. Letters In Animal Biology, 5(1), 121–128. https://doi.org/10.62310/liab.v5i1.252

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Review Articles
Recieved 2025-08-27
Accepted 2025-11-11
Published 2025-11-16

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