Intraepithelial lymphocytes and coeliac disease: permanent changes in CD3(-)/CD7(+) and T cell receptor gamma delta subsets studied by flow cytometry

Permanent changes in intestinal intraepithelial lymphocytes have been obser ved in coeliac patients. The aim of this investigation was to study small i ntestinal intraepithelial lymphocytes by using flow cytometry and to evalua te its diagnostic value in coeliac disease. Three-colour flow cytometry ana lyses were performed on isolated epithelial cells of 117 intestinal biopsie s obtained from 113 children (54 coeliac disease, 4 other enteropathies, 18 Helicobacter pylori associated gastritis and 37 normal controls). A multip le logistic regression model was developed to select the best intraepitheli al lymphocytes subset predictor of coeliac disease. Coeliac patients: had s ignificant higher levels of T cell receptor gamma delta intraepithelial lym phocytes than control patients (p < 0.01), H. pylori patients p < 0.01) and other enteropathies (p < 0.05). The density of CD3(-)/CD7(+) intraepitheli al lymphocytes, a intraepithelial lymphocyte subset poorly characterized by immunohistochemical methods, was significantly lower in coeliac patients t han in the control group (p < 0.01), H. pylori group (p < 0.01) and other e nteropathies (p < 0.01). Both changes remained altered independent of the c oeliac patient's diet. The data were used on a logistic regression analysis in order to calculate sensitivity [94.4%; 95% confidence interval (CI) 83. 7-98.6%], specificity (94.9%; 95% CI 84.9-98.7%) and likelihood ratio for a positive test 18.5 (95% CI 6.1-55.8) in the diagnosis of coeliac disease. Conclusion: Changes in T cell receptor gamma delta and CD3(-)/CD7(+) intrae pithelial lymphocytes subsets are permanently observed in paediatric coelia c disease. Their assessment, by three-colour flow cytometry on routine diag nostic biopsies, permits a better characterization of coeliac enteropathy a nd represents a valuable procedure to identify coeliac patients with differ ent clinical presentations.