New approaches to morphological diagnosis of gluten-sensitive celiac disease

Abstract

Aim. To characterize cell adhesion molecules (CAM), components of intercellular matrix (ICM) in gluten-sensitive celiac disease (GSCD). Material and methods. A histological examination was made of biopsies of small intestinal mucosa (SIM) obtained from 890 patients with clinical and laboratory symptoms of GSCD. Of them, 124(14%) patients had signs of chronic atrophic duodenitis of different severity corresponding to GSCD. Newly diagnosed GSCD was in 63(7.1%) patients, 61 (6,9 %) patients kept aglutenic diet. Biopsy specimens from unaffected mucosa of distal parts of the duodenum from 10 patients served control. Immunohistochemical examination of CAM and ICM was made using antibodies to E-cadgerin, beta-catenin, CD44, type IV collagen, matrix metalloproteinase of type 9 (MMP-9). Results. Interrupted weak reaction in epithelial basal membrane and enhanced expression of this antigen in stroma were observed in SIM in GSCD of stage IIIC by Marsh. Subnormal irregular expression of E-cadgerin and beta-catenin were seen in membrane of surface epithelium and cryptal epithelium. Moreover, high CD44 expression was detected in membrane of SIM stroma cells and high expression of MMP-9 in the cytoplasm of stromal cells and intercellular matrix. Conclusion. The detected disorders of intercellular and cellular-matrix interaction in GSCD promote tissue lesion, increased permeability of epithelial barrier and changes in histogenesis processes. Further study of minimal disorders in SIM in GSCD on the molecular level will facilitate diagnosis of early stages of the disease and prognosis of its course.

Keywords

• celiac disease
• immunohistochemical methods
• molecules of cellular adhesion
• intercellular matrix
• small intestine morphology