title: Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation.
abstract: OBJECTIVE
  Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics.
  
  
  METHODS
  Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and > or = 24 months post-transplantation. Results were correlated with the HLA type of the recipient.
  
  
  RESULTS
  Serological evidence of CD was found in 3% (ESALD) vs. 0.6% (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4%, P=0.0001) and EMAs (4.3 vs. 0.78%, P=0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100%, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD.
  
  
  CONCLUSIONS
  Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Abdulkarim
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Krause
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002446:Celiac Disease / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins / Q000032:analysis; D006084:Graft Rejection; D006085:Graft Survival; D006683:HLA-DQ Antigens / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D017093:Liver Failure / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D011503:Transglutaminases / Q000032:analysis
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins