Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal challenge in celiac sprue

Department of Medicine, University of Manchester School of Medicine, United Kingdom.
Gastroenterology (Impact Factor: 16.72). 08/1989; 97(1):29-37.
Source: PubMed


The immunopathologic, structural, and functional changes within rectal mucosa of known celiac sprue subjects were quantitated during local challenge with a peptic-tryptic digest of gluten. In the celiac sprue patients challenged with 2 g of digest, major effects occurred in lamina propria, submucosa, and local microvasculature. The lamina propria swelling was biphasic, starting 1-2 h after challenge with widespread extravascular deposition of fibrinogen, indicative of increased microvascular permeability, receding by 24 h postchallenge. A rapid fall in mast cells together with granule discharge suggested their involvement in this response. The late-phase swelling (48-72 h) was preceded by a rapid influx of neutrophils and basophils, the latter showing evidence of degranulation beyond 72 h. Reestablishment of vessel lumina, a rise in mast cells, and loss of neutrophils indicated tapering of the inflammatory cellular cascade by 96 h. Lymphocytes, first seen to enter the lamina by 2 h postchallenge, increased progressively, thereby resulting in substantial infiltration between 36 and 96 h. A marked rise in epithelial lymphocytes, maximal at 6-8 h, waned by 24 h. Volumes of surface and crypt epithelium remained constant throughout. In another challenge series with 4 g of gluten digest, electrical potential difference across rectal mucosa decreased significantly 12 h postchallenge, but the associated decreases in net sodium and chloride absorptive fluxes were insignificant. It is concluded that rectal mucosa is sensitized to gluten in celiac sprue disease and thus offers a promising and convenient in vivo substrate for investigative and diagnostic purposes.

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    • "However, small bowel biopsy from patients with isolated CD or in CD associated with DH shows that neutrophils are not the predominant cells; it is possible that neutrophils represent the earliest inflammatory cell, but the continued stimulation with gluten results in a transition to the more typical mononuclear cell infiltrate. Confirming this hypothesis, it has been demonstrated a pronounced neutrophilic activation in CD after rectal gluten challenge in the first 4–6 hours [76, 77]. "
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    ABSTRACT: Dermatitis herpetiformis (DH) is a rare autoimmune disease linked to gluten sensitivity with a chronic-relapsing course. It is currently considered to be the specific cutaneous manifestation of celiac disease (CD). Both conditions are mediated by the IgA class of autoantibodies, and the diagnosis of DH is dependent on the detection of granular deposits of IgA in the skin. There is an underlying genetic predisposition to the development of DH, but environmental factors are also important. This paper describes these different factors and discusses the known mechanism that lead to the development of skin lesions.
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    • "IL-8 is a potent neutrophil chemokine, however, neutrophils are not prominently noted in the small bowel biopsies of patients with isolated GSE or in the GSE associated with DH. It is of interest that in time course studies carried out after gluten challenges in the rectum of patients with isolated GSE, neutrophils were most prominently present in the first 4–6 hours (Loft et al., 1989; Kristjansson et al., 2005). This finding suggests that neutrophils may represent an early event after initial gluten challenge. "
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    ABSTRACT: Patients with dermatitis herpetiformis (DH) have a gluten-sensitive enteropathy and while on gluten-containing diets have elevated levels of serum IL-8. We hypothesized that the mucosal immune response to gluten is responsible for the elevated serum IL-8. Six DH patients were studied while on a gluten-free diet (GFD), whereas four continued on a normal diet. Patients were followed for a mean 2.2 years and serum IL-8 was analyzed. Small bowel biopsies from five DH patients on normal diets, two DH patients on GFD, and six subjects with no small bowel abnormalities were analyzed for IL-8 mRNA. Serum IL-8 levels normalized in five of six patients on GFD and decreased in one, whereas serum IL-8 levels showed no statistically significant change in DH patients on normal diets. Small bowel biopsies from DH patients on normal diets had increased expression of IL-8 mRNA compared to normal subjects, whereas patients on a GFD showed no significant increase in small bowel mRNA. No significant IL-8 mRNA was detected in normal skin biopsies from patients with DH. These observations suggest that the IL-8 in the serum of patients with DH originates from the small bowel as a mucosal immune response to gluten ingestion.
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    ABSTRACT: 44 patients referred consecutively for jejunal biopsy underwent rectal gluten challenge with 2 g peptic-tryptic digest (Frazer's fraction III; FF3). Rectal biopsy was done before the challenge and 6 h afterwards. Total intraepithelial lymphocytes (IEL) overlying a 104 μm2 test area of muscularis mucosae were quantified by computerised image analysis. The subjects comprised 21 controls with disorders other than coeliac disease and 23 patients (14 treated, 9 untreated) with coeliac disease diagnosed by strict jejunal biopsy gold standard criteria. There was no difference between the groups in IEL numbers before challenge. Coeliac disease patients but not controls responded to FF3 with a rise in mucosal IEL (median 60·5% rise for treated, 63·0% for untreated). There was no response to challenge with β-lactoglobulin in coeliac disease or control subjects. When a predefined, post-challenge IEL "predictive index" of more than 10% above baseline was used to indicate a diagnosis of coeliac disease, it gave a sensitivity of 90% and specificity of 91% (95% confidence intervals 78-93%). Rectal gluten challenge is a simple, safe, and reliable test of gluten sensitivity, both as a screening test for untreated coeliac disease and as a confirmatory test in patients with treated coeliac disease.
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