Distinction between coeliac disease and refractory sprue: a simple immunohistochemical method

Histopathology. 2000 Jul;37(1):70-7. doi: 10.1046/j.1365-2559.2000.00926.x.


Aims: We recently showed that refractory sprue is distinct from coeliac disease, the former being characterized by abnormal intraepithelial T-lymphocytes expressing a cytoplasmic CD3 chain (CD3c), lacking CD3 and CD8 surface expression, and showing TCRgamma gene rearrangements. To take advantage of the abnormal phenotype of CD3c + CD8 - intraepithelial lymphocytes (IEL) in refractory sprue we developed a simple method to distinguish coeliac disease from refractory sprue.

Methods and results: Comparative immunohistochemical studies using anti-CD3 and anti-CD8 antibodies were applied on paraffin-embedded and frozen biopsy specimens in refractory sprue (n = 6), coeliac disease (n = 10), healthy controls (n = 5) and suspected refractory sprue (n = 6). Comparable results were obtained on fixed and frozen biopsy specimens. In four of the six patients with suspected refractory sprue, abnormal CD3c + CD8 - IEL and TCRgamma gene rearrangements were found, as in refractory sprue; the remaining two patients had normal (CD3 + CD8 +) IEL and no TCRgamma gene rearrangements. Both patients had coeliac disease, as one failed to comply with a gluten-free diet, while the other was a slow responder.

Conclusion: This simplified immunostaining method using anti-CD3 and anti-CD8 antibodies on paraffin sections can distinguish active coeliac disease from refractory sprue and should prove useful in clinical practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • CD3 Complex / metabolism
  • CD8 Antigens / metabolism
  • Celiac Disease / metabolism
  • Celiac Disease / pathology*
  • Female
  • Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
  • Humans
  • Immunoenzyme Techniques
  • Male
  • Middle Aged
  • Phenotype
  • Polymerase Chain Reaction
  • Prospective Studies
  • Retrospective Studies


  • CD3 Complex
  • CD8 Antigens