Anti-microbial antibodies in celiac disease: Trick or treat?

作者：Papp Maria^*; Foldi Ildiko; Altorjay Istvan; Palyu Eszter; Udvardy Miklos; Tumpek Judit; Sipka Sandor; Korponay Szabo Ilma Rita; Nemes Eva; Veres Gabor; Dinya Tamas; Tordai Attila; Andrikovics Hajnalka; Norman Gary L; Lakatos Peter Laszlo

来源：World Journal of Gastroenterology, 2009, 15(31): 3891-3900.

DOI：10.3748/wjg.15.3891

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

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, antimicrobial 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.

• 出版日期2009-8-21