title: Is human umbilical cord the most suitable substrate for the detection of endomysium antibodies in the screening and follow-up of coeliac disease?
abstract: BACKGROUND
  Immunoglobulin A (IgA) anti-endomysium antibodies, the most reliable immunological marker for both the screening and follow-up of coeliac disease, need monkey oesophagus as antigenic substrate; this limits their use because of high costs and the exploitation of endangered species.
  
  
  OBJECTIVE
  (1) To compare the diagnostic accuracy of anti-endomysium antibodies detected by indirect immunofluorescence on monkey oesophagus and on human umbilical cord; (2) to evaluate their reliability during follow-up in detecting non-compliant patients.
  
  
  METHODS
  One hundred and four untreated adults with biopsy-proven coeliac disease and 94 controls were investigated.
  
  
  RESULTS
  Endomysium antibodies were found in 99 patients (95%) on both substrates, with a specificity, respectively, of 100% and 99% on monkey oesophagus and umbilical cord. One year after gluten withdrawal, out of 47 patients who were investigated, only six presented with complete mucosal recovery: none of these subjects was positive on either substrates, while, among patients with persistent histological alterations, endomysium positivity persisted in only 10 on monkey oesophagus, but in 32 on umbilical cord. Histology (recovery or persistent involvement) was in agreement with endomysium (negative or positive) in 34% on monkey oesophagus, but in 81% on umbilical cord (P < 0.0001).
  
  
  CONCLUSIONS
  Human umbilical cord, with its comparable diagnostic efficiency, could replace monkey tissues, with the advantages of saving both money and monkeys. Moreover, it seems the most suitable substrate in the follow-up, as it enables detection of non-compliant patients with persisting mucosal alterations.
authors.affiliation: Dipartimento di Medicina Interna, Cattedra di Gastroenterologia, University of Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sategna-Guidetti
authors.forename: S B
authors.initials: SB
authors.lastname: Grosso
authors.forename: M
authors.initials: M
authors.lastname: Bruno
authors.forename: S
authors.initials: S
authors.lastname: Grosso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001323:Autoantibodies / Q000276:immunology; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology*; D004947:Esophagus / Q000276:immunology*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005983:Glutens / Q000009:adverse effects; D000882:Haplorhini; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000276:immunology*; D012680:Sensitivity and Specificity; D014470:Umbilical Cord / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D005983:Glutens