Brief Articles
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World J Gastroenterol. Aug 21, 2009; 15(31): 3891-3900
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3891
Anti-microbial antibodies in celiac disease: Trick or treat?
Maria Papp, Ildiko Foldi, Istvan Altorjay, Eszter Palyu, Miklos Udvardy, Judit Tumpek, Sandor Sipka, Ilma Rita Korponay-Szabo, Eva Nemes, Gabor Veres, Tamas Dinya, Attila Tordai, Hajnalka Andrikovics, Gary L Norman, Peter Laszlo Lakatos
Maria Papp, Ildiko Foldi, Istvan Altorjay, Eszter Palyu, Miklos Udvardy, 2nd Department of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
Judit Tumpek, Sandor Sipka, Laboratory of Clinical Immunology, University of Debrecen, Debrecen, H-4032, Hungary
Ilma Rita Korponay-Szabo, Eva Nemes, Department of Pediatrics, University of Debrecen, Debrecen, H-4032, Hungary
Ilma Rita Korponay-Szabo, Celiac Disease Center, Heim Pal Children's Hospital, Budapest, H-1089, Hungary
Gabor Veres, 1st Department of Pediatrics, Semmelweis University, Budapest, H-1083, Hungary
Tamas Dinya, Institute of Surgery, University of Debrecen, Debrecen, H-4032, Hungary
Attila Tordai, Hajnalka Andrikovics, Department of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, H-1113, Hungary
Gary L Norman, INOVA Diagnostics, Inc., San Diego, CA 92131-1638, United States
Peter Laszlo Lakatos, 1st Department of Medicine, Semmelweis University, Budapest, H-1083, Hungary
Author contributions: Papp M and Foldi I contributed equally to this work; Papp M designed the research, supervised the collection of research material and patients data and prepared the manuscript; Tumpek J, Sipka S, Foldi I, Palyu E performed serology analysis; Tordai A, Andrikovics H performed genetic analysis; Dinya T, Korponay-Szabo IR, Altorjay I, Nemes E, Veres G recruited patients and prepared clinical data; Norman GL, Udvardy M supervised manuscript preparation and oversaw data analyis; Lakatos PL designed the research, analyzed the data and prepared the manuscript.
Correspondence to: Maria Papp, MD, PhD, 2nd Department of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary. drpappm@yahoo.com
Telephone: +36-52-255152
Fax: +36-52-255152
Received: May 19, 2009
Revised: July 20, 2009
Accepted: July 27, 2009
Published online: August 21, 2009
Abstract

AIM: To determine the prevalence of a new set of anti-glycan and anti-outer membrane protein (anti-OMP) antibodies in a Hungarian cohort of adult Celiac disease (CD) patients.

METHODS: 190 consecutive CD patients [M/F: 71/119, age:39.9 (SD:14.1) years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae (gASCA), anti-laminaribioside (ALCA), anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet (GFD).

RESULTS: 65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, anti-microbial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity (LR+: 3.13; 95% CI: 2.08-4.73) was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis (P = 0.019).

CONCLUSION: The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.

Keywords: Celiac disease; Glycans; Anti-Saccharomyces cerevisiae antibodies; Anti-outer membrane protein antibody; NOD2/CARD15; Gluten-free diet; Presenting symptoms; Bacterial translocation; Crohn’s disease