Increased density of jejunal gamma delta(+) T cells in patients having normal mucosa - Marker of operative autoimmune mechanisms?

Both from a clinical and a biological point of view, coeliac disease can be classified among the autoimmune diseases, or one could suspect autoimmune mechanisms to be operative in the disease. The aim of the present study mas to find evidence for mucosal markers of coeliac disease latency in patient s clinically suspected but on routine biopsy excluded for the disease. Mono clonal antibodies were used to stain jejunal intraepithelial lymphocytes an d mucosal HLA-DR, Serum IgA-class reticulin autoantibodies were measured by an indirect immunofluorescence and gliadin antibodies by an enzyme-linked immunosorbent assay method. The DQA1*0501 and DQB1*0201 alleles were determ ined. Twenty-seven of 107 consecutive patients had coeliac disease. Altoget her 39 of 79 (49%) children with normal jejunal mucosa had an increased den sity of intraepithelial gamma delta(+) T cells (greater than or equal to 4. 4 cells/mm), IgA-class reticulin autoantibodies mere positive in 18 (23%) o f the children excluded for coeliac disease. The antibody positivity was mo stly seen in patients carrying the DQA1*0501 and DQB1*0201 alleles, Also, r eticulin autoantibody-positive children having normal jejunal mucosal morph ology had significantly higher densities of intraepithelial gamma delta(+) T cells than antibody negative ones. On 1.5-4.5 year follow-up four out of 18 (22%) children primarily excluded for coeliac disease showed mucosal det erioration and coeliac disease. Many patients clinically suspected of coeli ac disease but having normal jejunal mucosa show markers of coeliac disease latency which may be gluten-induced indicating autoimmune mechanisms to be operative in the gut.