title: Discriminant score for celiac disease based on immunohistochemical analysis of duodenal biopsies.
abstract: OBJECTIVE
  Celiac disease (CD) represents a spectrum, which includes cases with minor histological abnormalities (potential CD). The aim of this work is to evaluate the contribution of immunohistochemical analysis of duodenal biopsies to the diagnosis of gluten-related minor enteropathy.
  
  
  METHODS
  Duodenal biopsies from 56 patients with untreated CD and 56 controls were analyzed for CD3 and γδ intraepithelial lymphocyte number, γδ/CD3 ratio, and density of CD25+ lamina propria cells. A discriminant equation was obtained by which 61 more biopsies with normal villous architecture were blindly evaluated.
  
  
  RESULTS
  All of the immunohistochemical parameters were significantly different between patients with CD and controls. None of the single parameters showed sufficient specificity for CD. The combination of all of the 4 markers resulted in the following discriminant equation: discriminant score (Dscore) = (CD3 × 0.06) - (γδ × 0.119) + (CD25 × 0.012) + (γδ/CD3 × 0.131) - 4.709. Using this Dscore, patients were correctly classified as celiac or controls in 97.3% of the cases. When this equation was applied to a validation set of 61 patients with normal villous architecture and unknown diagnosis, 92.9% of those with a positive score turned out to be patients with potential CD. A normal score, however, did not exclude this condition.
  
  
  CONCLUSIONS
  Immunohistochemistry represents a specific tool for the diagnosis of CD, but does lack sensitivity in detecting all of the potential CD cases.
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosco
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Maglio
authors.forename: Francesco
authors.initials: F
authors.lastname: Paparo
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.forename: Riccardo
authors.initials: R
authors.lastname: Troncone
authors.forename: Renata
authors.initials: R
authors.lastname: Auricchio
mesh_terms: D000293:Adolescent; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000737:chemistry* / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins / Q000097:blood; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007223:Infant; D053645:Interleukin-2 Receptor alpha Subunit / Q000032:analysis; D007413:Intestinal Mucosa / Q000737:chemistry* / Q000473:pathology; D018655:Lymphocyte Count; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D013601:T-Lymphocytes / Q000737:chemistry*; D011503:Transglutaminases / Q000097:blood
chemical_list: D017252:CD3 Complex; D007070:Immunoglobulin A; D053645:Interleukin-2 Receptor alpha Subunit; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins