title: Serum I-FABP Detects Gluten Responsiveness in Adult Celiac Disease Patients on a Short-Term Gluten Challenge.
abstract: Response to gluten challenge (GC) is a key feature in diagnostic algorithms and research trials in celiac disease (CD). Currently, autoantibody titers, late responders to GC, and invasive duodenal biopsies are used to evaluate gluten responsiveness. This study investigated the accuracy of serum intestinal-fatty acid binding protein (I-FABP), a marker for intestinal epithelial damage, to predict intestinal damage during GC in patients with CD.
  
  
  
  Twenty adult CD patients in remission underwent a two-week GC with 3 or 7.5 g of gluten daily. Study visits occurred at day -14, 0, 3, 7, 14, and 28. Serum I-FABP, antibodies to tissue transglutaminase (tTG-IgA), deamidated gliadin peptides (IgA-DGP), and anti-actin (AAA-IgA) were assessed at each visit. Villous-height to crypt-depth ratio (Vh:Cd) and intraepithelial lymphocyte (IEL) count were evaluated at day -14, 3, and 14. Forty-three CD-serology negative individuals were included to compare serum I-FABP levels in CD patients on a gluten-free diet (GFD) with those in healthy subjects.
  
  
  
  Serum I-FABP levels increased significantly during a two-week GC. In contrast, the most pronounced autoantibody increase was found at day 28, when patients had already returned to a GFD for two weeks. IgA-AAA titers were only significantly elevated at day 28. I-FABP levels and IEL count correlated at baseline (r=0.458, P=0.042) and at day 14 (r=0.654, P=0.002) of GC. Neither gluten dose nor time on a GFD influenced I-FABP change during GC.
  
  
  
  Serum I-FABP levels increased significantly during a two-week GC in adult CD patients and correlated with IEL count. The data suggest that serum I-FABP is an early marker of gluten-induced enteropathy in celiac patients and may be of use in both clinical and research settings.
authors.affiliation: Department of Pediatrics and Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Marlou P M
authors.initials: MP
authors.lastname: Adriaanse
authors.affiliation: Department of Gastroenterology, Celiac Disease Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.affiliation: Department of Gastroenterology, Celiac Disease Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Ciaran P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: Department of Gastroenterology, Celiac Disease Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.|Institute of Translational Immunology, Research Center of Immunology (FZI), University Medical Center, Mainz, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Najarian
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Goldsmith
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.affiliation: Department of Pediatrics and Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Anita C E
authors.initials: AC
authors.lastname: Vreugdenhil
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy / Q000503:physiopathology; D003938:Diagnostic Techniques, Digestive System; D055050:Diet, Gluten-Free / Q000379:methods*; D042241:Early Diagnosis; D050556:Fatty Acid-Binding Proteins / Q000032:analysis / Q000097:blood; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D005903:Gliadin / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage / Q000378:metabolism; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D018655:Lymphocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D015203:Reproducibility of Results; D013223:Statistics as Topic; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D005983:Glutens; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins