Distinction between coeliac disease and refractory sprue: a simple immunohistochemical method

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Patey-Mariaud de Serre, N | Cellier, C | Jabri, B | Delabesse, Eric | Verkarre, V | Roche, B | Lavergne, A | Brière, J | Mauvieux, L | Leborgne, M | Barbier, J | Modigliani, R | Matuchansky, C | Macintyre, E | Cerf-Bensussan, N | Brousse, N

Edité par CCSD ; Wiley -

International audience. Aims We recently showed that refractory sprue is distinct from coeliac disease, the former being characterized by abnormal intraepithelial T‐lymphocytes expressing a cytoplasmic CD3 chain (CD3c), lacking CD3 and CD8 surface expression, and showing TCR γ gene rearrangements. To take advantage of the abnormal phenotype of CD3c + CD8 − intraepithelial lymphocytes (IEL) in refractory sprue we developed a simple method to distinguish coeliac disease from refractory sprue. Methods and results Comparative immunohistochemical studies using anti‐CD3 and anti‐CD8 antibodies were applied on paraffin‐embedded and frozen biopsy specimens in refractory sprue ( n = 6), coeliac disease ( n = 10), healthy controls ( n = 5) and suspected refractory sprue ( n = 6). Comparable results were obtained on fixed and frozen biopsy specimens. In four of the six patients with suspected refractory sprue, abnormal CD3c + CD8 − IEL and TCR γ gene rearrangements were found, as in refractory sprue; the remaining two patients had normal (CD3 + CD8 +) IEL and no TCR γ gene rearrangements. Both patients had coeliac disease, as one failed to comply with a gluten‐free diet, while the other was a slow responder. Conclusion This simplified immunostaining method using anti‐CD3 and anti‐CD8 antibodies on paraffin sections can distinguish active coeliac disease from refractory sprue and should prove useful in clinical practice.

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