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


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 TCRgamma gene rearrangements were found, as in refractory sprue; the remaining two patients had normal (CD3 + CD8 +) IEL and no TCRgamma gene rearrangements. Both patients had coeliac disease, as one failed to comply with a gluten-free diet, while the other was a slow responder.


CONCLUSIONS
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.
Patey-Mariaud De Serre
N
N
Department of Pathology and Université René Descartes-Paris V (EA 219), INSERM E 9925, Paris, France.
Cellier
C
C
Jabri
B
B
Delabesse
E
E
Verkarre
V
V
Roche
B
B
Lavergne
A
A
Brière
J
J
Mauvieux
L
L
Leborgne
M
M
Barbier
J P
JP
Modigliani
R
R
Matuchansky
C
C
MacIntyre
E
E
Cerf-Bensussan
N
N
Brousse
N
N
D000328:Adult; D000368:Aged; D017252:CD3 Complex / Q000378:metabolism; D016827:CD8 Antigens / Q000378:metabolism; D002446:Celiac Disease / Q000378:metabolism / Q000473:pathology*; D005260:Female; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012189:Retrospective Studies
D017252:CD3 Complex; D016827:CD8 Antigens