AIM:To investigate the association between serum antibody levels and a subsequent celiac disease diag-nosis in a large series of children and adults. METHODS:Besides subjects with classical gastrointestinal presentati...AIM:To investigate the association between serum antibody levels and a subsequent celiac disease diag-nosis in a large series of children and adults. METHODS:Besides subjects with classical gastrointestinal presentation of celiac disease,the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups.Altogether 405 patients underwent clinical,serological and histological evaluations.After collection of data,the antibody values were further graded as low[endomysial(EmA)1:5-200,transglutaminase 2 antibodies(TG2-ab)5.0-30.0 U/L]and high (EmA 1:≥500,TG2-ab≥30.0 U/L),and the serological results were compared with the small intestinal mucosal histology and clinical presentation. RESULTS:In total,79%of the subjects with low and 94%of those with high serum EmA titers showed small-bowel mucosal villous atrophy.Furthermore, 96%of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a glutencontaining diet,or responded positively to a glutenfree diet. CONCLUSION:Irrespective of the initial serum titers or clinical presentation,EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.展开更多
Celiac disease is a multisystemic dietary,gluten-induced autoimmune disorder characterized by the presence of transglutaminase(TG)2 serum autoantibodies.Distinct autoantibodies targeting members of the TG family(TG2,T...Celiac disease is a multisystemic dietary,gluten-induced autoimmune disorder characterized by the presence of transglutaminase(TG)2 serum autoantibodies.Distinct autoantibodies targeting members of the TG family(TG2,TG3 and TG6)are found deposited in small-bowel mucosa and in extraintestinal tissues affected by the disease.Serum autoantibodies against other self-antigens also emerge in untreated celiac disease patients.Although villous atrophy and crypt hyperplasia in small-bowel biopsy samples are still the gold standards in diagnostics,celiac disease-specific antibodies are widely used as diagnostic aids.Gluten-induced small-bowel mucosal T-cell response is the cornerstone in the pathogenesis of the disorder,but humoral immunity may also play a central role.This review article is focused on the autoantibodies that occur in the context of celiac disease.The article summarizes the diagnostic utility of different celiac-related antibodies and discusses their roles in the pathogenesis of the disease.展开更多
基金Supported by The Academy of Finland Research Council for Healththe Competitive Research Funding of the Pirkanmaa Hospital District+5 种基金the Sigrid Juselius Foundationthe Foundation for Paediatric Researchthe National Graduate School of Clinical Investigationthe Ehrnrooth Foundationthe Finnish Gastroenterology Societythe Finnish Pediatric Society and the Finnish Celiac Society
文摘AIM:To investigate the association between serum antibody levels and a subsequent celiac disease diag-nosis in a large series of children and adults. METHODS:Besides subjects with classical gastrointestinal presentation of celiac disease,the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups.Altogether 405 patients underwent clinical,serological and histological evaluations.After collection of data,the antibody values were further graded as low[endomysial(EmA)1:5-200,transglutaminase 2 antibodies(TG2-ab)5.0-30.0 U/L]and high (EmA 1:≥500,TG2-ab≥30.0 U/L),and the serological results were compared with the small intestinal mucosal histology and clinical presentation. RESULTS:In total,79%of the subjects with low and 94%of those with high serum EmA titers showed small-bowel mucosal villous atrophy.Furthermore, 96%of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a glutencontaining diet,or responded positively to a glutenfree diet. CONCLUSION:Irrespective of the initial serum titers or clinical presentation,EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.
基金Celiac Disease Study Group has been financially supported by the Academy of Finland,the Sigrid Juselius Fundation,the Pediatric Research Foundation,the Competitive Research Funding of Tampere University Hospital and the European Commission IAPP frant TRANSCOM(contract number PIA-GA-2010-251506).
文摘Celiac disease is a multisystemic dietary,gluten-induced autoimmune disorder characterized by the presence of transglutaminase(TG)2 serum autoantibodies.Distinct autoantibodies targeting members of the TG family(TG2,TG3 and TG6)are found deposited in small-bowel mucosa and in extraintestinal tissues affected by the disease.Serum autoantibodies against other self-antigens also emerge in untreated celiac disease patients.Although villous atrophy and crypt hyperplasia in small-bowel biopsy samples are still the gold standards in diagnostics,celiac disease-specific antibodies are widely used as diagnostic aids.Gluten-induced small-bowel mucosal T-cell response is the cornerstone in the pathogenesis of the disorder,but humoral immunity may also play a central role.This review article is focused on the autoantibodies that occur in the context of celiac disease.The article summarizes the diagnostic utility of different celiac-related antibodies and discusses their roles in the pathogenesis of the disease.