title: Anti-microbial antibodies in celiac disease: trick or treat?
abstract: OBJECTIVE
  To determine the prevalence of a new set of anti-glycan and anti-outer membrane protein (anti-OMP) antibodies in a Hungarian cohort of adult Celiac disease (CD) patients.
  
  
  METHODS
  190 consecutive CD patients [M/F: 71/119, age:39.9 (SD:14.1) years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae (gASCA), anti-laminaribioside (ALCA), anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet (GFD).
  
  
  RESULTS
  65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, anti-microbial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity (LR+: 3.13; 95% CI: 2.08-4.73) was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis (P = 0.019).
  
  
  CONCLUSIONS
  The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.
authors.affiliation: 2nd Department of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary. drpappm@yahoo.com
authors.forename: Maria
authors.initials: M
authors.lastname: Papp
authors.forename: Ildiko
authors.initials: I
authors.lastname: Foldi
authors.forename: Istvan
authors.initials: I
authors.lastname: Altorjay
authors.forename: Eszter
authors.initials: E
authors.lastname: Palyu
authors.forename: Miklos
authors.initials: M
authors.lastname: Udvardy
authors.forename: Judit
authors.initials: J
authors.lastname: Tumpek
authors.forename: Sandor
authors.initials: S
authors.lastname: Sipka
authors.forename: Ilma Rita
authors.initials: IR
authors.lastname: Korponay-Szabo
authors.forename: Eva
authors.initials: E
authors.lastname: Nemes
authors.forename: Gabor
authors.initials: G
authors.lastname: Veres
authors.forename: Tamas
authors.initials: T
authors.lastname: Dinya
authors.forename: Attila
authors.initials: A
authors.lastname: Tordai
authors.forename: Hajnalka
authors.initials: H
authors.lastname: Andrikovics
authors.forename: Gary L
authors.initials: GL
authors.lastname: Norman
authors.forename: Peter Laszlo
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000097:blood / Q000276:immunology; D000906:Antibodies / Q000097:blood / Q000276:immunology; D000907:Antibodies, Bacterial / Q000276:immunology*; D000908:Antibodies, Fungal / Q000276:immunology*; D001425:Bacterial Outer Membrane Proteins / Q000276:immunology; D002446:Celiac Disease / Q000097:blood* / Q000276:immunology* / Q000503:physiopathology; D004252:DNA Mutational Analysis; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics; D011134:Polysaccharides / Q000276:immunology
chemical_list: D000890:Anti-Infective Agents; D000906:Antibodies; D000907:Antibodies, Bacterial; D000908:Antibodies, Fungal; D001425:Bacterial Outer Membrane Proteins; D053473:Nod2 Signaling Adaptor Protein; D011134:Polysaccharides
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