GAMMA-DELTA T-CELLS AND THE DIAGNOSIS OF CELIAC-DISEASE

Gamma/delta T cells are increased in the gut epithelium of patients with coeliac disease compared with normal controls. The aim of this study was to determine whether the increase in gamma-delta-intraepithelial lymphocytes (IEL) is specific for coeliac disease, in which case it could be of diagnostic importance. Biopsies were obtained from children with no intestinal disease, coeliac disease, cow-milk-sensitive enteropathy/post-enteritis syndrome (CMSE/PES) and miscellaneous other enteropathies (n = 67). Intraepithelial CD3+ and gamma-delta-T cells were identified in frozen sections using peroxidase immunohistochemistry. In normal biopsies there were 0-7-gamma-delta-IEL/100 cells in the epithelium. In untreated coeliac patients this increased to 9-22-gamma-delta-IEL/100 cells in the epithelium (P = 0.000004). Of 27 patients with morphologic intestinal damage which was not due to coeliac disease, four with CMSE/PES had gamma-delta-IEL-100 cells in the epithelium in the same range as the patients with coeliac disease. Of these, two had high densities of CD3+ IEL in the epithelium and were indistinguishable from patients with untreated coeliac disease. The other two could be excluded as possible coeliacs because their CD3+ IEL/100 epithelial cells were in the normal range. Thus an increase in gamma-delta-IEL is not specific for coeliac disease. However, enumeration of both of gamma-delta-IEL and CD3+ IEL densities will be useful in the exclusion of coeliac disease as a diagnosis in some children.