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Serum and Tissue CD23, IL-15, and FasL in Cow's-Milk Protein–sensitive Enteropathy and in Coeliac Disease

Kokkonen, Tuomo S.*; Augustin, Merja T.*; Kokkonen, Jorma†,†; Karttunen, Riitta; Karttunen, Tuomo J.*

Journal of Pediatric Gastroenterology & Nutrition: April 2012 - Volume 54 - Issue 4 - p 525–531
doi: 10.1097/MPG.0b013e318237c145
Original Articles: Hepatology and Nutrition

Objectives: The aim of the study was to explore pathogenesis and find new serum markers for cow's-milk–sensitive enteropathy (CMSE) and coeliac disease (CD). We assessed the intestinal expression and serum concentration of CD23, IL-15, and FasL. We hypothesised that the serum levels of CD23, a protein expressed in the lymphoid follicles, would be associated with lymphonodular hyperplasia (LNH), a feature characteristic of CMSE. We also presumed that interleukin (IL)-15 and FasL, functionally connected with proliferation and apoptosis of the intraepithelial lymphocytes (IELs), would relate with the increased numbers of IELs present in both CMSE and CD.

Methods: Twenty-three children with CMSE, 20 with untreated CD, and 14 controls were studied for CD3, α/β- and γ/δ-expressing IELs, and for duodenal and ileal expression of CD23, FasL, and IL-15 by immunohistochemistry, and for serum concentration of sCD23, sFasL, and sIL-15 by enzyme-linked immunosorbent assay.

Results: There was a trend for increase in sCD23 serum levels in untreated CMSE and in CD (P = 0.074; P = 0.077). CD23 was expressed in the mucosal germinal centres, but sCD23 was not related to presence of LNH. In CMSE, there was a trend for increase in serum sFasL (P = 0.07) and high levels associated with LNH (P = 0.025) and correlated with the IEL numbers (P < 0.05). Mucosal high endothelial venules adjacent to lymphoid follicles showed an intensive FasL expression.

Conclusions: Serum sCD23 shows a trend of increment in CMSE and CD, and in the latter, sCD23 level may provide information about the severity of villous atrophy. In CMSE, high serum sFasL indicates both LNH and an increase of IELs, suggesting importance of FasL-mediated mechanisms in the pathogenesis of these features characteristic of CMSE. Further studies are necessary to evaluate whether intensive FasL expression in mucosal high endothelial venules presents a regulatory element in mucosal immunity.

*Department of Pathology, University of Oulu

Department of Medical Microbiology and Immunology, Oulu University, Oulu, Finland.


Address correspondence and reprint requests to Tuomo J. Karttunen, Department of Pathology, University of Oulu, P.O. Box 5000, FIN-90014 Oulu, Finland (e-mail:

Received 4 March, 2011

Accepted 13 September, 2011

The study was supported by the Alma and KA Snellman Foundation and the Foundation for Paediatric Research.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN