Abstract
AimThe enumeration of intraepithelial lymphocytes subsets (total, γδ, and CD3– IELs) by flow cytometry (FCM), named as IEL lymphogram, constitutes a useful tool for celiac disease (CD) diagnosis. The aim of this study was to quantify IELs by FCM and their diagnostic value to differentiate active, silent and potential CD.MethodsProspective study of 60 active and 20 silent CD patients, and 161 controls in which duodenal biopsy and IEL quantification by FCM was performed.ResultsActive and silent CD patients had significant higher levels of both total and γδ IELs than absent CD patients (P < 0.0001 and P < 0.0001, P = 0.012 and P < 0.011; respectively). Active and silent CD patients had significant lower levels of CD3– IELs than absent CD patients (P < 0.047 and P < 0.009, respectively). Moreover, they were lower in silent than in active CD patients (P = 0.002). Changes of IELs subsets were more marked in children than adults active CD. The optimal IEL lymphogram cut off values for active CD diagnosis were: ≥10, ≥15 and ≤9 %, and with better performance characteristics for silent CD: ≥ 11, ≥10 and ≤5 %.ConclusionThe evaluation of IELs subsets by FCM is useful to confirm diagnosis of active and silent CD.
Highlights
Celiac disease (CD) is an autoimmune enteropathy induced by gluten in genetically predisposed patients and characterized by intestinal inflammation with lymphocytic intraepithelial infiltration and villous atrophy [1].Intraepithelial lymphocytes (IELs) represent an abundant and heterogeneous population of antigen-experienced T cells that reside in the intestinal epithelium
The optimal IEL lymphogram cut off values for active celiac disease (CD) diagnosis were: C10, C15 and B9 %, and with better performance characteristics for silent CD: C 11, C10 and B5 %
CD is an immune-mediated enteropathy caused by an abnormal immune response to dietary gluten proteins, characterized by altered IELs pattern
Summary
Intraepithelial lymphocytes (IELs) represent an abundant and heterogeneous population of antigen-experienced T cells that reside in the intestinal epithelium. They are composed of T cells bearing the ab (ab IELs [90 %) or the cd T cell receptor (cd IELs \10 %). It has been reported that IELs are increased in the duodenal/jejunum mucosa of untreated CD patients and would represent the earliest feature even seen when the villous architecture is preserved. They alone can constitute the first sign of latent or potential forms of CD [3,4,5,6]. Increased IELs are considered a hallmark of CD, not disease-specific [2, 7]
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