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. 2020 Jan:51:102567.
doi: 10.1016/j.ebiom.2019.11.028. Epub 2020 Jan 2.

Diagnostic accuracy and applicability of intestinal auto-antibodies in the wide clinical spectrum of coeliac disease

Luigina De Leo  1 , Matteo Bramuzzo  1 , Fabiana Ziberna  1 , Vincenzo Villanacci  2 , Stefano Martelossi  1 , Grazia Di Leo  1 , Chiara Zanchi  1 , Fabiola Giudici  3 , Michela Pandullo  3 , Petra Riznik  4 , Alberto Di Mascio  1 , Alessandro Ventura  3 , Tarcisio Not  5
Affiliations

Diagnostic accuracy and applicability of intestinal auto-antibodies in the wide clinical spectrum of coeliac disease

Luigina De Leo et al. EBioMedicine. 2020 Jan.

Abstract

Background: Intestinal coeliac auto-antibodies are the marker of coeliac disease (CD). Since the determination of these antibodies is still not widely available, we used immunoassays to identify the most suitable technology for revealing intestinal auto-antibodies in the wide clinical spectrum of CD.

Methods: Intestinal auto-antibodies have been prospectively investigated in CD suspected children using two immunoassays: intestinal-deposits of IgA anti-tissue transglutaminase antibodies (anti-tTG) and biopsy-culture IgA anti-endomysium (AEA). Intestinal IgM antibodies have been determined in IgA-deficient subjects.

Findings: Two-hundred and twenty-one suspected CD patients were enrolled. Intestinal antibodies were tested positive for both assays in classical CD patients (n = 178) with villous atrophy and positive serum-CD antibodies, potential CD patients (n = 16) with normal intestinal mucosa and positive serum-CD antibodies, and pre-potential CD patients (n = 14) with normal intestinal mucosa and negative serum-CD antibodies. In 13/221 with normal intestinal mucosa, negative CD-serum antibodies and negative intestinal antibodies CD has been excluded. All classical, 14/16 potential and 11/14 pre-potential CD patients on gluten-free diet (GFD) improved their symptoms. In 9/11 pre-potential patients intestinal antibodies disappeared on GFD. Both assays were negative in 69/71 control subjects. The two assays showed high diagnostic sensitivity (100%) and specificity (99%).

Interpretation: Intestinal CD-antibodies make prompt diagnosis in the wide clinical spectrum of CD reducing the delay in diagnosis and treatment, especially in pre-potential CD patients. The easy handling biopsy culture assay is an effective diagnostic tool which should be carried out by any gastroenterology unit to recognize all CD clinical manifestations.

Funding: Interreg Central-Europe, IRCCS "Burlo Garofolo".

Keywords: Biopsy culture; Coeliac disease; Diagnosis; Gluten-free diet; Intestinal deposits.

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Conflict of interest statement

Declaration of competing interest All authors declare no competing interest.

Figures

Fig 1
Fig. 1
Intestinal IgA anti-tTG deposits ((a) yellow spots in sub-epithelium, and (b) around crypts) and intestinal AEA in culture supernatant ((c) fluorescent network) at the diagnosis and disappearance of both specific fluorescent signals ((d),(e) intestinal IgA anti-tTG deposits, and (f): intestinal AEA in culture supernatant) after 12 months of gluten-free diet.
See this image and copyright information in PMC

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