Anti-microbial antibodies in celiac disease: trick or treat?
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.
Papp
Maria
M
2nd Department of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary. drpappm@yahoo.com
Foldi
Ildiko
I
Altorjay
Istvan
I
Palyu
Eszter
E
Udvardy
Miklos
M
Tumpek
Judit
J
Sipka
Sandor
S
Korponay-Szabo
Ilma Rita
IR
Nemes
Eva
E
Veres
Gabor
G
Dinya
Tamas
T
Tordai
Attila
A
Andrikovics
Hajnalka
H
Norman
Gary L
GL
Lakatos
Peter Laszlo
PL
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
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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