Immunohistochemical staining of the duodenal intraepithelial lymphocytes for CD3+, and CD8+ T cells in celiac patients: first report on cell density counts of the duodenal intraepithelial lymphocytes in Isfahan population, Iran

Background: Increased numbers of the duodenal intraepithelial lymphocytes (IEL) are one of the key histological findings in celiac disease (CD). However, this finding may vary from one region to another. There are cases of borderline histology and seronegative CD which might be different from other causes of the duodenal immunological reactions by measuring the mean percentages of IEL expressing the α/ßTCR, γ/δTCR, CD3, CD4, and CD8 markers. This study aimed to measure the total CD3+, CD8+ IEL T cells in celiac patients and healthy controls in Isfahan, Iran. Methods: D2 biopsies from definite CD cases (17 cases) and healthy controls (22 cases) were evaluated. H&E staining and several monoclonal antibodies were used in this study by the immunoperoxidase staining method. Results: Immunoperoxidase staining method showed that the mean total IEL was 19 and 40 in the control subjects and CD cases, respectively (P≤0.05). The upper normal limit of the CD3+ intraepithelial T cells (mean+2SD of IEL T cells counts in the controls) was 20, while it was 14% for the CD8+ T cells. In addition, the H&E staining method showed the upper normal limit of 34% for IEL in CD. Conclusions: This study suggests that the total IEL are of > 34%, CD3+ IEL > 20% and CD8+ IELs > 14% by the immunoperoxidase staining technique. These might be considered as Marsh I among the general population of Isfahan. Thus, in cases which there are disagreement between the serology and H&E staining methods, immunoproxidase staining of IEL has an additional value in CD diagnosis.

Keywords:

Celiac disease , duodenal biopsy , intestinal intraepithelial lymphocytes , normal range