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. 2019 Aug 31;14(1):98.
doi: 10.1186/s13000-019-0878-1.

An association between crypt apoptotic bodies and mucosal flattening in celiac disease patients exposed to dietary gluten

Michael Lee  1 , Shane Betman  2 , Alina Iuga  2 , Hui-Min Yang  2 , Jude Fleming  3 , Peter H R Green  4 , Benjamin Lebwohl  4 , Stephen M Lagana  2
Affiliations

An association between crypt apoptotic bodies and mucosal flattening in celiac disease patients exposed to dietary gluten

Michael Lee et al. Diagn Pathol. .

Abstract

Background: Celiac disease (CD) is characterized histologically by inflammation and villous atrophy. Villous atrophy is thought to result from a disruption of epithelial cellular proliferation and death. Epithelial cells in intestinal mucosa normally proliferate in the crypts and migrate towards the lumen, eventually dying. Apoptotic bodies in crypts are usually abnormal and are associated with certain disease states. The presence of crypt apoptosis in celiac disease has not been thoroughly examined by routine histologic assessment of crypt apoptotic body count (ABC).

Methods: We quantified the ABC in duodenal biopsies from celiac patients before and after initiation of a gluten-free diet (GFD). We examined twenty-three duodenal biopsies from adult patients with celiac disease at diagnosis and following GFD and determined the maximum ABC in 10 consecutive crypts. Fourteen biopsies from heartburn patients served as controls.

Results: Mean duration between paired biopsies was 2.9 (0.5-8.5) years. Mean maximum ABC in active celiac disease was 5.44 per crypt and decreased to 2.60 with GFD (p = <.0001). The mean maximum ABC in controls was 1.79, lower than both active celiac disease and GFD (p = <.0001 and p = .019 respectively). Flat lesions with total villous atrophy (mean: 6.44) showed a higher ABC compared to non-flat lesions (mean: 4.87); p = .04.

Conclusions: Crypt ABC is markedly elevated in active celiac disease and decreases significantly with GFD, however it does not achieve normalcy. Total villous atrophy is associated with a higher ABC than all other lesions. Crypt apoptosis is likely a significant contributor to villous atrophy in celiac disease and can be appreciated by routine histologic examination.

Keywords: Apoptosis; Celiac disease; Pathology.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1.
Fig. 1.
An apoptotic body demonstrates condensed nuclear chromatin and eosinophilia (arrow)
Fig. 2.
Fig. 2.
Multiple crypt apoptotic bodies and fragments of karyorrhectic debris (arrows) fulfill criteria for an apoptotic body in a patient with a Marsh 3C lesion
Fig. 3.
Fig. 3.
This flat lesion returned to a state of relative normalcy after 24 months. Such recovery was associated with a reduction of the ABC, though it remained higher than the mean ABC of controls
Fig. 4.
Fig. 4.
The flat lesion from Figure 3 returned to a state of normalcy after 24 months
See this image and copyright information in PMC

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