{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:13:03Z","timestamp":1790784783644,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2018,3,29]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Refractory coeliac disease type II (RCDII), a rare complication of coeliac disease (CD) associated with high morbidity, requires identification of a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs) for diagnosis. However, data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII are limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active CD, 172\u2009CD on gluten-free diet (GFD), 33 RCDI, and three RCDII patients and 14 patients without CD. TCR-GR patterns were divided into clonal, polyclonal and prominent clonal peaks (PCPs) and these patterns were correlated with clinical and pathological features.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Clonal TCR-GR products were detected in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with GFD. PCPs were observed in all disease phases (range 12%\u201333%). There was no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). A higher frequency of surface CD3(\u2212) IELs was noted in cases with clonal TCR-GR, but the PCP pattern did not show associations with any clinical or pathological feature. Persistence of clonal or PCP pattern on repeat biopsy was seen for up to 2 years without evidence of RCDII.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jclinpath-2018-205023","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T12:25:38Z","timestamp":1524831938000},"page":"825-831","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Clonal T cell receptor gene rearrangements in coeliac disease: implications for diagnosing refractory coeliac disease"],"prefix":"10.1136","volume":"71","author":[{"given":"Shafinaz","family":"Hussein","sequence":"first","affiliation":[{"name":"Department of Pathology and Cell Biology, New York Presbyterian Hospital\/Columbia University Medical Center, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatyana","family":"Gindin","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, New York Presbyterian Hospital\/Columbia University Medical Center, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M","family":"Lagana","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology, New York Presbyterian Hospital\/Columbia University Medical Center, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Arguelles-Grande","sequence":"additional","affiliation":[{"name":"Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital\/Columbia University Medical Center, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneeta","family":"Krishnareddy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Celiac Disease 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