Serological responses to microbial antigens in celiac disease patients during a gluten-free diet.
BACKGROUND
Immunoglobulin A (IgA) autoantibodies to tissue transglutaminase (tTG) are commonly used for screening and diagnosing of celiac disease (CD). Seroreactivity for anti-Saccharomyces cerevisiae antibody (ASCA) and bacterial antigens have also been detected in CD patients. The aim of this study was to examine prospectively serologic responses to microbial targets in adult CD patients at the time of diagnosis and during a gluten-free diet (GFD). Further, we wanted to evaluate whether these serologic specificities could provide new tools for the follow-up of CD patients.


METHODS
Data on 55 adult biopsy-proven CD patients were available for follow-up study. Upper gastrointestinal endoscopy was performed on all patients. Sera from patients were tested for antibodies to tTG and ASCA and additionally analyzed with IgA enzyme-linked immunosorbent assays to Pseudomonas fluorescens-associated sequence, I2, and to a Bacteroides caccae TonB-linked outer membrane protein, OmpW.


RESULTS
At the time of diagnosis, 91% of CD cases were positive for tTG and 49% for ASCA; positive seroreactivity to I2 was found in 86% and to OmpW in 60% of CD patients at the time of diagnosis. The frequency of seropositivity and serum levels of these antibodies decreased during GFD. Moreover, we found that the decline in the serum levels was significant in all of these markers (p < 0.005). Interestingly, we also found that serum levels of ASCA correlated with the grade of mucosal morphology (p = 0.021), as the ASCA serum levels declined in accordance with mucosal healing.


CONCLUSIONS
Commensal enteric bacteria seem to play a role in the small intestinal mucosal damage in CD. This was proven by the serological responses to different microbial antigens shown in this study. Serum levels of ASCA, anti-I2, and anti-OmpW antibodies decreased significantly during GFD, indicating that these serologic markers are gluten dependent in CD patients. These specificities could provide new tools in the follow-up of CD patients.
Ashorn
Sara
S
Paediatric Research Centre and Medical School, University of Tampere and Tampere University Hospital, Tampere, Finland.
Välineva
Tuuli
T
Kaukinen
Katri
K
Ashorn
Merja
M
Braun
Jonathan
J
Raukola
Hanna
H
Rantala
Immo
I
Collin
Pekka
P
Mäki
Markku
M
Luukkaala
Tiina
T
Iltanen
Sari
S
D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood*; D000908:Antibodies, Fungal / Q000097:blood*; D000942:Antigens, Bacterial / Q000276:immunology; D001425:Bacterial Outer Membrane Proteins / Q000097:blood; D001439:Bacteroides / Q000276:immunology; D002446:Celiac Disease / Q000276:immunology* / Q000382:microbiology / Q000473:pathology; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens / Q000276:immunology; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011551:Pseudomonas fluorescens / Q000276:immunology; D012441:Saccharomyces cerevisiae / Q000276:immunology*; D018089:Superantigens / Q000097:blood; D011503:Transglutaminases / Q000276:immunology*
D000907:Antibodies, Bacterial; D000908:Antibodies, Fungal; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; C437325:OmpW protein, Bacteroides caccae; C469916:PfiT protein, Pseudomonas fluorescens; D018089:Superantigens; D005983:Glutens; D011503:Transglutaminases