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Gut 2001;48:425-429 ( March )

Case reports

Role of interferon  in promoting T helper cell type 1 responses in the small intestine in coeliac disease G Monteleone^a, S L F Pender^a, E Alstead^b, A C Hauer^c, P Lionetti^d, T T MacDonald^a

^a Division of Infection, Allergy, Inflammation, and Repair, University of Southampton, School of Medicine, Southampton General Hospital, Southampton, UK, ^b Digestive Diseases Research Centre, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK, ^c Universitatsklinik fur Kinder und Jugenheilkunde, Karl-Franzens- Universitat, Graz, Austria, ^d Dipartimento di Pediatria, Universita' di Firenze, Florence, Italy

Correspondence to: T T MacDonald, Division of Infection, Allergy, Inflammation, and Repair, School of Medicine, Southampton General Hospital, MailPoint 813, Level E, South Academic Block, Tremona Road, Southampton SO16 6YD, UK. t.t.macdonald{at}soton.ac.uk

Accepted for publication 31 October 2000

Coeliac disease (CD) is caused by a CD4 T helper cell type 1 (Th1) response in the small intestinal mucosa to dietary gluten. As the major Th1 inducing cytokine, interleukin 12, is undetectable in CD gut mucosa, the mechanism by which Th1 effector cells are generated remains unknown. Interferon (IFN) , a cytokine capable of promoting IFN- synthesis, has been implicated in the development of Th1 mediated immune diseases. Here we report a case of CD-like enteropathy in a patient receiving IFN- for chronic myeloid leukaemia. Morphological assessment of duodenal biopsies taken from the patient showed total villous atrophy, crypt cell hyperplasia, and a high number of CD3⁺ intraepithelial lymphocytes. Both antigliadin antibodies and antiendomysial antibodies were positive. RNA analysis revealed pronounced expression of IFN-. Withdrawal of gluten from the diet resulted in a patchy improvement in intestinal morphology, normalisation of laboratory parameters, and resolution of clinical symptoms. By western blot analysis, IFN- protein was seen in the duodenal mucosa from untreated CD patients but not in controls. This was associated with marked expression of IFN- protein in CD mucosa. Collectively, these results suggest a role for IFN- in promoting Th1 responses to gluten.


Keywords: coeliac disease; interferon; small intestine; T helper cell response

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© 2001 by Gut

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