Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies

Abstract

Patients with gluten-sensitive enteropathy usually have increased numbers of duodenal intraepithelial lymphocytes even if the villous architecture is normal. Some authors advocate the use of CD8 and CD3 immunohistochemical stains to improve detection of intraepithelial lymphocytosis, yet the added value of immunohistochemistry when biopsies appear normal remains unproven. The purpose of this study was to evaluate the utility of CD3 and CD8 immunostains in detecting intraepithelial lymphocytosis among duodenal biopsies originally interpreted to be normal based on routine evaluation. We identified 200 duodenal biopsies from 172 patients, all of which were accompanied by a clinical question of gluten-sensitive enteropathy. Five well-oriented villi from each biopsy were assessed. Intraepithelial lymphocytes present in hematoxylin and eosin (H&E)-stained slides were counted and compared with the number of CD3 and CD8 immunopositive cells present in the villous epithelium. Results were expressed as the mean number of intraepithelial lymphocytes or immunopositive cells present per 20 villous tip enterocytes. Review of H&E-stained slides revealed a mean of 2.1 ± 0.1 intraepithelial lymphocytes, compared with 3.2 ± 0.1 CD3-positive and 2.1 ± 0.1 CD8-positive intraepithelial cells (P ¼ o0.001 and 1, respectively), although none of the cases displayed sufficient numbers of intraepithelial lymphocytes to be considered abnormal (ie, Z12/20 enterocytes) by any method. The number of intraepithelial lymphocytes detected by H&E evaluation or immunohistochemistry did not correlate with results of serologic studies for markers of gluten sensitivity. We conclude that immunostains for T cell markers do not improve detection of gluten-sensitive enteropathy when H&E-stained sections are normal.

Effect of ochratoxin A on the intestinal mucosa and mucosa-associated lymphoid tissues in broiler chickens

“…Intraepithelial lymphocytes are active components of the mucosal immune system, the number of which increases under the influence of various antigens from the intestinal lumen (microorganisms or toxic agents). Large numbers of CD4+ lymphocytes were observed in the duodenum and at the ileocaecal junction because of local stimulation by various antigens and in relation to age and associated antigenic aggressions (Hudacko et al, 2013). Cholera toxin primarily acts through augmenting CD4+ T cell priming, leading to a strong induction of antigen-specific T cells of both the T helper Th1 and Th2 subtypes (Hörnquist et al, 1996).…”

Diagnosing Celiac Disease: Role of the Pathologists

“…17 CD3+ IEL) was found in another recent study [6]. On the other hand, the routine use of immunohistochemistry is not recommended by others, because it can decrease sensitivity of observing the loss of "decrescendo pattern" [7] and in fact does not improve detection of glutensensitive enteropathy when hematoxylin and eosin-stained sections are normal [11].…”

Celiac disease: From pathophysiology to treatment

“…Although still debated, recently, Mubarak et al[49] have shown that staining for CD3 has an additional value in the histological detection of celiac disease lesions[49,50]. Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies.…”