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Cheung T, de Zoeten EF, Hofenberg EJ, Liu E, Pan Z, Walker T, Stahl M. Characteristics of Children With Inflammatory Bowel Disease and Coexisting Celiac Disease Seropositivity. J Pediatr Gastroenterol Nutr 2022; 75:737-742. [PMID: 36122373 PMCID: PMC11017732 DOI: 10.1097/mpg.0000000000003613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Celiac disease (CeD) autoimmunity and coexisting inflammatory bowel disease (IBD) present a diagnostic dilemma. Our aims were to describe the phenotype of children with IBD and CeD seropositivity and evaluate provider confidence for diagnosing CeD in this population. METHODS We performed a single-center retrospective cohort study of subjects ≤18 years old with IBD and CeD seropositivity between 2006 and 2020. Subjects were considered to have IBD-CeD if they met CeD diagnosis by serology and histology per North American Society For Pediatric Gastroenterology, Hepatology and Nutrition guidelines and if providers suspected CeD as evaluated by a survey. The IBD-only cohort included seropositive participants that did not meet criteria for CeD. Demographic, histologic, gross endoscopic, and laboratory features were compared using Fisher exact test. RESULTS Of 475 children with IBD, 8 had concomitant CeD, 5 had tissue transglutaminase (tTG) immunoglobulin A (IgA) > 10x upper limit of normal (ULN, P = 0.006), and 8 had villous atrophy (VA, P = 0.003) when compared with 17 seropositive participants with IBD-only. No children with IBD-CeD had esophageal eosinophilia, duodenal cryptitis, duodenal ulceration, or fecal calprotectin >250 µg/g. Factors that contributed to provider uncertainty for diagnosing CeD in IBD included the absence of VA and intraepithelial lymphocytes, the presence of neutrophilic and eosinophilic duodenitis, diffuse ulceration, elevated inflammatory markers, and immunosuppression therapy. CONCLUSIONS Diagnosing CeD in children with IBD continues to be challenging. Although high titers of tTG IgA and VA increased provider confidence for diagnosing CeD in IBD, development of evidence-based guidelines are needed. They should better assess the importance of features atypical of concomitant CeD that contribute to uncertainty.
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Affiliation(s)
- Telly Cheung
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
| | - Edwin F. de Zoeten
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
| | - Edward J. Hofenberg
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
| | - Edwin Liu
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
| | - Zhaoxing Pan
- Biostatistics Core of Children’s Hospital Colorado Research Institute, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Thomas Walker
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
| | - Marisa Stahl
- Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, and the
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Prevalance of Celiac Disease in Patients with Inflammatory Bowel Disease in Turkish Population. Gastroenterol Res Pract 2019; 2019:6272098. [PMID: 31885543 PMCID: PMC6927052 DOI: 10.1155/2019/6272098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background Celiac disease (CD) and inflammatory bowel disease (IBD) involve inflammation of the gastrointestinal lumen, which environmental, genetic, and immunological factors have a role in their pathogenesis. The prevalence of celiac disease in IBD ranges from 0% to 14%. In this study, our aim was to determine the prevalence of CD in IBD patients followed by us who are attending the hospital or outpatient clinic over a period of time of seven years. Methods Seven hundred and fifty nine patients (425 M, 334 F, mean age: 46.75, 396 ulcerative colitis (UC), 363 Crohn's disease (CrD)) diagnosed and followed up for IBD between January 2009 and July 2016 were evaluated retrospectively, and clinical, demographic, laboratory, and endoscopic data were collected. Results CD was investigated in 79 (%10.4) inflammatory bowel disease patients according to symptoms, and in 5.06% (n = 4) of them, we diagnosed CD. The most common indication for investigating for CD was iron deficiency anemia unreponsive to iron supplementation. Conclusions We did not find an increased prevalance of celiac disease in Turkish IBD patients in this study. In the presence of refractory iron deficiency anemia without any other cause in IBD patients, investigations for celiac disease should be considered.
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Roca M, Donat E, Marco-Maestud N, Masip E, Hervás-Marín D, Ramos D, Polo B, Ribes-Koninckx C. Efficacy Study of Anti-Endomysium Antibodies for Celiac Disease Diagnosis: A Retrospective Study in a Spanish Pediatric Population. J Clin Med 2019; 8:jcm8122179. [PMID: 31835690 PMCID: PMC6947542 DOI: 10.3390/jcm8122179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to assess the efficacy of anti-endomysium antibodies (EMA) as a serological marker for celiac disease (CD) diagnosis in a pediatric population. A retrospective study of pediatric patients who underwent a CD serological markers study: EMA and anti-tissue transglutaminase antibodies (anti-TG2). Clinical symptomatology, degree of histological lesion, human leukocyte antigen (HLA) haplotype compatible with CD (HLA DQ2 and/or DQ8), and final diagnosis were taken into account. We included 445 patients who were classified in two groups according to the final diagnosis. Group 1: 232 children with CD, 91.4% of whom exhibited small intestinal villous atrophy, 228 being EMA-positive and four EMA-negative. Group 2: 213 children with a non-CD diagnosis, 212 EMA negative and one EMA positive. Both antibodies, EMA and anti-TG2, reached similar sensitivities, 98% and 99% respectively, while EMA had a higher specificity (99%) than anti-TG2 (93%). By using both markers combined, compared to using anti-TG2 alone, 5.7% of patients are better diagnosed. However, when we compare the efficacy of EMA and anti-TG2 in asymptomatic and symptomatic patients, the sensitivity of EMA is 98% irrespective of symptoms, thus higher than for anti-TG2 ≥10 × upper limit of normal (ULN) (respectively 77% and 84%). Our results support the use of EMA to increase CD diagnostic accuracy in a non-biopsy approach, especially in asymptomatic children.
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Affiliation(s)
- María Roca
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
- Correspondence: ; Tel.: +34-961-246-660; Fax: +34-961-246-224
| | - Ester Donat
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
- Pediatric Gastrohepathology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Natalia Marco-Maestud
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
| | - Etna Masip
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
- Pediatric Gastrohepathology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - David Hervás-Marín
- Statistics Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain;
| | - David Ramos
- Pathology Service, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Begoña Polo
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
- Pediatric Gastrohepathology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Carmen Ribes-Koninckx
- Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (E.D.); (N.M.-M.); (E.M.); (B.P.); (C.R.-K.)
- Pediatric Gastrohepathology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
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Abstract
GOAL The aim of this analysis was to assess in patients with inflammatory bowel disease (IBD) the risk of celiac disease and in celiac disease patients the risk of IBD. BACKGROUND Previous studies report a possible association between IBD and celiac disease; however, this link is controversial. STUDY Using the search terms "inflammatory bowel disease" and "celiac disease," we identified initially 1525 publications. In total 27 studies met inclusion criteria. Proportions and 95% confidence intervals (CIs) for the prevalence of IBD in celiac disease and vice versa were compared with published prevalence rates for the respective geographic regions. RESULTS We included 41,482 adult IBD patients (20,357 with Crohn's disease; 19,791 with ulcerative colitis; and 459 patients with celiac disease). Overall, in IBD patients the prevalence of celiac disease was 1110/100,000 (95% CI, 1010-1210/100,000) as compared with a prevalence of 620/100,000 (95% CI, 610-630/100,000) in the respective populations (odds ratio, 2.23; 95% CI, 1.99-2.50). In contrast, in patients with celiac disease, 2130/100,000 had IBD (95% CI, 1590-2670/100,000) as compared with 260/100,000 (95% CI, 250/100,000-270/100,000) in the respective populations (odds ratio, 11.10; 95% CI, 8.55-14.40). This effect was not different for ulcerative colitis and Crohn's disease. Although there was no evidence for publication bias for celiac disease in IBD, the funnel plot suggested that the association between IBD in celiac disease might be influenced by publication bias. CONCLUSIONS The data are consistent with the notion that celiac disease is a risk factor for IBD and to lesser degree patients with IBD have an increased risk of celiac disease.
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Prevalence of Anti-tissue Transglutaminase Antibodies and Celiac Disease in Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2018; 66:934-936. [PMID: 29287008 DOI: 10.1097/mpg.0000000000001877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Celiac disease can occur in children with inflammatory bowel disease (IBD) and poses a diagnostic challenge. We evaluated the presence of anti-tissue transglutaminase (tTG) antibodies and celiac disease among children with IBD. METHODS In a retrospective chart review, we assessed the prevalence of tTG antibodies and celiac disease and compared with a control group of children with gastrointestinal symptoms without IBD. RESULTS Study population included 130 children with IBD and 257 in the control group. Abnormal tTG levels were found in 6 and 20 patients, respectively (4.6% vs 7.8%, P = 0.24). One patient with IBD and 12 in the control group had celiac disease (0.8% vs 4.7%, P = 0.07). CONCLUSIONS False-positive tTG can occur in children with IBD. The prevalence of celiac disease is not increased in children with IBD compared with non-IBD children with gastrointestinal symptoms and is similar to that in the general population.
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Stewart TJ, Bazergy C. Hormonal and dietary factors in acne vulgaris versus controls. DERMATO-ENDOCRINOLOGY 2018; 10:e1442160. [PMID: 29904568 PMCID: PMC5997051 DOI: 10.1080/19381980.2018.1442160] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
Background: Acne vulgaris is an inflammatory skin disorder with not as yet fully understood pathogenesis. In this controlled study, we assessed acne vulgaris patients for several possible pathogenic factors such as vitamin D deficiency, vegan diet, increased body mass index (BMI) and positive anti-transglutaminase antibody. Methods: We screened 10 years of records at a family medicine clinic for patients diagnosed with acne vulgaris. In eligible subjects, we collected data regarding 25-hydroxylvitamin D levels, BMI, dietary preference and serum IgA tissue transglutaminase levels. Controls were age- (+/− 12 months) and sex-matched patients seen during the study period without a diagnosis of acne vulgaris. Results: 453 patients were given a diagnosis of acne vulgaris during the study period. Compared with controls, we found significant associations between vitamin D deficiency (<50nmol/L), and/or positive transglutaminase antibody level (>4.0U/mL) and a diagnosis of acne vulgaris. Conclusions: Our study adds important information to the current body of literature in pursuit of elucidating the pathogenesis of this complex multifactorial disease.
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Affiliation(s)
- Thomas Jonathan Stewart
- Darlinghurst Medical Centre, Darlinghurst, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Carl Bazergy
- Kogarah Railway Medical Centre, Kogarah, Sydney, Australia
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Iseme RA, Mcevoy M, Kelly B, Agnew L, Walker FR, Attia J. Is osteoporosis an autoimmune mediated disorder? Bone Rep 2017; 7:121-131. [PMID: 29124082 PMCID: PMC5671387 DOI: 10.1016/j.bonr.2017.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/01/2017] [Accepted: 10/15/2017] [Indexed: 12/12/2022] Open
Abstract
The last two decades have marked a growing understanding of the interaction occurring between bone and immune cells. The chronic inflammation and immune system dysfunction commonly observed to occur during the ageing process and as part of a range of other pathological conditions, commonly associated with osteoporosis has led to the recognition of these processes as important determinants of bone disease. This is further supported by the recognition that the immune and bone systems in fact share regulatory mechanisms and progenitor molecules. Research into this complex synergy has provided a better understanding of the immunopathogenesis underlying bone diseases such as osteoporosis. However, existing research has largely focussed on delineating the role played by inflammation in pathogenic bone destruction, despite increasing evidence implicating autoantibodies as important drivers of osteoporosis. This review shall attempt to provide a comprehensive overview of existing research examining the role played by autoantibodies in osteoporosis in order to determine the potential for further research in this area. Autoantibodies represent promising targets for the improved treatment and diagnosis of inflammatory bone loss.
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Affiliation(s)
- Rosebella A. Iseme
- Department of Population and Reproductive Health, School of Public Health, Kenyatta University, P.O. Box 43844 –, 00100, Nairobi, Kenya
- School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Mark Mcevoy
- School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Brian Kelly
- School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, NSW, Australia
| | - Linda Agnew
- Brain Behaviour Research Group, School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
| | - Frederick R. Walker
- School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Laboratory of Affective Neuroscience, The University of Newcastle, Callaghan, NSW, Australia
- University of Newcastle, Medical Sciences MS413, University Drive, Callaghan, NSW 2308, Australia
| | - John Attia
- School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
- Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Engstrom N, Saenz-Méndez P, Scheers J, Scheers N. Towards Celiac-safe foods: Decreasing the affinity of transglutaminase 2 for gliadin by addition of ascorbyl palmitate and ZnCl 2 as detoxifiers. Sci Rep 2017; 7:77. [PMID: 28250436 PMCID: PMC5427931 DOI: 10.1038/s41598-017-00174-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
Initiation of celiac disease is triggered in the gastrointestinal tract by transglutaminase 2 (TG2) assisted deamidation of gluten peptides. Deamidation is a side-reaction to transamidation and occurs if primary amines are absent. In contrast to deamidation, transamidation does not trigger an immune response. The aim of the study was to identify a suitable food additive that interacts with TG2 binding motives in gluten-derived peptides to prevent deamidation/transamidation. Homology modelling of α2-gliadin and computational screening of compounds for their binding affinity to a common TG2 binding motive (P)QLP were done by using computational approaches followed by experimental testing of TG2 activity. A database containing 1174 potential food grade ligands was screened against the model of α2-gliadin (27 out of 33 aa). Out of the five best ligands, ascorbyl palmitate, was observed to decrease TG2 transamidation of gliadin by 82% ± 2%. To completely silence the transamidation, we added zinc chloride (ZnCl2), and thereby reached a 99% ± 1% inhibition of TG2 activity. In addition, we conducted a pilot experiment in which ascorbyl palmitate was observed to decrease TG2 deamidation of gliadin completely. We propose ascorbyl palmitate in combination with ZnCl2 with the future perspective to become an additive in celiac-safe foods.
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Affiliation(s)
- N Engstrom
- Chalmers University of Technology, Department of Biology and Biological Engineering, The division of Food and Nutrition Science, 412 96, Gothenburg, Sweden
| | - P Saenz-Méndez
- University of Gothenburg, Department of Chemistry and Molecular Biology, 405 30, Gothenburg, Sweden
- UdelaR, Facultad de Química, Computational Chemistry and Biology Group, 11800, Montevideo, Uruguay
| | - J Scheers
- Chalmers University of Technology, Department of Physics, 412 96, Gothenburg, Sweden
| | - N Scheers
- Chalmers University of Technology, Department of Biology and Biological Engineering, The division of Food and Nutrition Science, 412 96, Gothenburg, Sweden.
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Jeong EM, Son YH, Choi Y, Kim JH, Lee JH, Cho SY, Kim IG. Transglutaminase 2 is dispensable but required for the survival of mice in dextran sulfate sodium-induced colitis. Exp Mol Med 2016; 48:e267. [PMID: 27811936 PMCID: PMC5133373 DOI: 10.1038/emm.2016.95] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/27/2022] Open
Abstract
Transglutaminase 2 (TG2) is a ubiquitously expressed enzyme that catalyzes crosslinking, polyamination or deamidation of glutamine residues in proteins. It has been reported that TG2 is involved in the pathogenesis of various inflammatory diseases including celiac disease, pulmonary fibrosis, cystic fibrosis, multiple sclerosis and sepsis. Recently, using a mouse model of bleomycin-induced lung fibrosis, we showed that TG2 is required to trigger inflammation via the induction of T helper type 17 (Th17) cell differentiation in response to tissue damage. However, the role of TG2 in inflammatory bowel disease (IBD), which is thought to be a Th17 cell-associated disease, has remained elusive. In this study, we investigated the role of TG2 in dextran sulfate sodium (DSS)-induced colitis, the most widely used mouse model for IBD. Age- and sex-matched wild-type and TG2-/- mice were fed 2% DSS for 7 days or 3.5% DSS for 5 days in drinking water. An in situ TG activity assay revealed that DSS treatment activates TG2 in various colon cell types, including columnar absorptive cells and goblet cells. DSS-treated TG2-/- mice showed lower interleukin (IL)-6, but higher IL-17A and RORγt (retinoic acid receptor-related orphan receptor-γt) expression levels in the colon tissues than that in the wild-type mice. Moreover, TG2-/- mice showed higher mortality than the wild-type mice because of DSS treatment. Nevertheless, we found no significant differences in changes of body weight, colon length, morphology, immune cell infiltration and in vivo intestinal permeability between DSS-treated wild-type and TG2-/- mice. These results indicate that TG2-mediated Th17 cell differentiation is not required for the pathogenesis of DSS-induced acute colitis.
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Affiliation(s)
- Eui Man Jeong
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Hoon Son
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yewon Choi
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Hee Kim
- Department of Anatomy, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Haeng Lee
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Yup Cho
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - In-Gyu Kim
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, South Korea
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Rauhavirta T, Hietikko M, Salmi T, Lindfors K. Transglutaminase 2 and Transglutaminase 2 Autoantibodies in Celiac Disease: a Review. Clin Rev Allergy Immunol 2016; 57:23-38. [DOI: 10.1007/s12016-016-8557-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Schwartz KR, El Saleeby CM, Nimkin K, Friedmann AM, Moon A, Zukerberg LR. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 11-2016. A 12-Year-Old Boy with Malaise, Fevers, Abdominal Pain, and Pallor. N Engl J Med 2016; 374:1466-76. [PMID: 27074070 DOI: 10.1056/nejmcpc1512458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin R Schwartz
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Chadi M El Saleeby
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Katherine Nimkin
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Alison M Friedmann
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Aeri Moon
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
| | - Lawrence R Zukerberg
- From the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Pediatrics (K.R.S., C.M.E.S., A.M.F., A.M.), Radiology (K.N.), and Pathology (L.R.Z.), Harvard Medical School - both in Boston
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12
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Kocsis D, Tóth Z, Csontos ÁA, Miheller P, Pák P, Herszényi L, Tóth M, Tulassay Z, Juhász M. Prevalence of inflammatory bowel disease among coeliac disease patients in a Hungarian coeliac centre. BMC Gastroenterol 2015; 15:141. [PMID: 26481725 PMCID: PMC4612406 DOI: 10.1186/s12876-015-0370-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022] Open
Abstract
Background Celiac disease, Crohn disease and ulcerative colitis are inflammatory disorders of the gastrointestinal tract with some common genetic, immunological and environmental factors involved in their pathogenesis. Several research shown that patients with celiac disease have increased risk of developing inflammatory bowel disease when compared with that of the general population. The aim of this study is to determine the prevalence of inflammatory bowel disease in our celiac patient cohort over a 15-year-long study period. Methods To diagnose celiac disease, serological tests were used, and duodenal biopsy samples were taken to determine the degree of mucosal injury. To set up the diagnosis of inflammatory bowel disease, clinical parameters, imaging techniques, colonoscopy histology were applied. DEXA for measuring bone mineral density was performed on every patient. Results In our material, 8/245 (3,2 %) coeliac disease patients presented inflammatory bowel disease (four males, mean age 37, range 22–67), 6/8 Crohn’s disease, and 2/8 ulcerative colitis. In 7/8 patients the diagnosis of coeliac disease was made first and inflammatory bowel disease was identified during follow-up. The average time period during the set-up of the two diagnosis was 10,7 years. Coeliac disease serology was positive in all cases. The distribution of histology results according to Marsh classification: 1/8 M1, 2/8 M2, 3/8 M3a, 2/8 M3b. The distribution according to the Montreal classification: 4/6 Crohn’s disease patients are B1, 2/6 Crohn’s disease patients are B2, 2/2 ulcerative colitis patients are S2. Normal bone mineral density was detected in 2/8 case, osteopenia in 4/8 and osteoporosis in 2/8 patients. Conclusions Within our cohort of patients with coeliac disease, inflammatory bowel disease was significantly more common (3,2 %) than in the general population.
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Affiliation(s)
- Dorottya Kocsis
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Zsuzsanna Tóth
- Peterfy S. u. Hospital, Gastroenterology Unit, Péterfy S. st. 8-20., 1076, Budapest, Hungary.
| | - Ágnes A Csontos
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Pál Miheller
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Péter Pák
- Vaszary Kolos. Hospital, Gastroenterology Unit, Petőfi S. st. 26-28., 2500, Esztergom, Hungary.
| | - László Herszényi
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Miklós Tóth
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Zsolt Tulassay
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
| | - Márk Juhász
- 2nd Department of Medicine, Semmelweis University, Szentkirályi st. 46., 1088, Budapest, Hungary.
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IgG anti-tTG responses in different autoimmune conditions differ in their epitope targets and subclass usage. Mol Immunol 2015; 67:369-76. [DOI: 10.1016/j.molimm.2015.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/18/2015] [Accepted: 06/24/2015] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Although the incidence of inflammatory bowel diseases (IBD) in Japan has increased, the prevalence of celiac disease is considered very low with the lowest genetic disposition. IBD is reported as the most common comorbidity because of the high positive rate of serological celiac markers. The aim of this study was to examine the current incidence of celiac disease, especially in IBD patients in Japan, where both wheat consumption and incidence of IBD have increased. METHODS A total of 172 patients with IBD and 190 controls in Japan were screened for serum antibody of tissue transglutaminase and deaminated gliadin peptide. In sero-positive patients, HLA testing and upper gastrointestinal endoscopy with duodenal biopsy was performed. Some of the sero-positive patients started a gluten-restricted or unrestricted diet, and serological change was determined. RESULTS The positivity of both serum antibodies was significantly higher in IBD and correlated with disease activity. However, no biopsy-defined or HLA-defined true celiac disease was found. A decrease in serum antibody titers was observed with a gluten-restricted diet. CONCLUSIONS Despite the increased incidence of IBD and high positivity for serum celiac antibody in Japanese IBD patients, no true-positive celiac disease was noted, suggesting the presence of gluten intolerance in these populations.
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Picarelli A, Di Tola M, Borghini R, Isonne C, Saponara A, Marino M, Casale R, Tiberti A, Pica R, Donato G, Frieri G, Corazziari E. Colonic Involvement in Celiac Disease and Possible Implications of the Sigmoid Mucosa Organ Culture in its Diagnosis. J Clin Immunol 2013; 33:1250-6. [DOI: 10.1007/s10875-013-9920-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/24/2013] [Indexed: 12/12/2022]
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16
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Damasiewicz-Bodzek A, Wielkoszyński T. Serologic markers of celiac disease in psoriatic patients. J Eur Acad Dermatol Venereol 2008; 22:1055-61. [DOI: 10.1111/j.1468-3083.2008.02713.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Di Tola M, Barillà F, Trappolini M, Palumbo HF, Gaudio C, Picarelli A. Antitissue transglutaminase antibodies in acute coronary syndrome: an alert signal of myocardial tissue lesion? J Intern Med 2008; 263:43-51. [PMID: 18088251 DOI: 10.1111/j.1365-2796.2007.01881.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Antitransglutaminase, previously considered identical to antiendomysial in coeliac sprue (CS), have been reported in end-stage heart failure. To clarify the above-mentioned data, we evaluated these antibodies in a cohort of cardiological patients with respect to troponin I, creatine kinase (CK), MB fraction creatine kinase (CK-MB mass) and myoglobin. METHODS Forty-one patients with acute coronary syndrome (ACS), 39 with dilated cardiomyopathy (DCM), 45 with CS and 58 blood donors (BDs) were evaluated. Antitransglutaminase and antiendomysial antibodies were tested in serum of the patients being studied. RESULTS High-positive antitransglutaminase values were found in CS, whilst low-positive values were also found in ACS and DCM. In patients at the second ACS, antibody levels were higher than in those at the first cardiac event. In patients with infarct Q, antitransglutaminase were higher than those in infarct non-Q, in which antibody levels were higher than those in unstable angina. A correlation between antitransglutaminase and troponin I, CK, CK-MB mass and myoglobin was found. Finally, antibody levels rose to reach a peak at 30 days from the cardiac event, whereas after further 150 days, approached the values of BDs. Antiendomysial were detectable only in CS. CONCLUSIONS Data highlight that antitransglutaminase can occur in cardiological patients, and that these antibodies are related to the severity/extent of the myocardial tissue lesion. This feature suggests a loss of specificity for antitransglutaminase in CS. Furthermore, the possibility of employing these antibodies in the long-term follow-up of ACS, could become an object of interesting discussion.
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Affiliation(s)
- M Di Tola
- Department of Clinical Sciences, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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18
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Leeds JS, Höroldt BS, Sidhu R, Hopper AD, Robinson K, Toulson B, Dixon L, Lobo AJ, McAlindon ME, Hurlstone DP, Sanders DS. Is there an association between coeliac disease and inflammatory bowel diseases? A study of relative prevalence in comparison with population controls. Scand J Gastroenterol 2007; 42:1214-20. [PMID: 17918008 DOI: 10.1080/00365520701365112] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The relationship between coeliac disease and inflammatory bowel disease (IBD) is controversial. The aim of this study was to determine the prevalence of coeliac disease in IBD and the prevalence of IBD in coeliac disease. MATERIAL AND METHODS Patients were enrolled from specialist IBD and coeliac clinics. Antigliadins, endomysial, tissue transglutaminase antibody and total IgA levels were measured in IBD patients. Patients with positive antibodies were offered a duodenal biopsy. The notes on coeliac patients were reviewed for colonoscopic and biopsy findings. Controls were recruited from the local population. RESULTS The study included 305 patients with coeliac disease, 354 with IBD and 601 healthy controls. The IBD group comprised 154 ulcerative colitis (UC) cases, 173 Crohn's disease, 18 indeterminate colitis and 9 cases of microscopic colitis. Forty-seven patients had positive antibodies and 3 had villous atrophy on biopsy. All three patients had positive anti-tissue transglutaminase antibodies but only two were endomysial antibody (EMA) positive. Ten coeliac patients had IBD (5 UC and 5 lymphocytic colitis). Five controls had coeliac disease and 2 had IBD (1 Crohn's disease and 1 UC). Stepwise multiple logistic regression showed only antibody positivity as being significant (p<0.0001). CONCLUSIONS The prevalence of IBD in coeliac disease was increased 10-fold compared with that in controls (odds ratio 9.98, 95% CI 2.8-45.9, p=0.0006), while the prevalence of coeliac disease in IBD was comparable with that in controls (odds ratio 1.02, 95% CI, 0.24-4.29, p=1.0).
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Affiliation(s)
- John S Leeds
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
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19
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Tursi A. Anti-tissue transglutaminase in inflammatory bowel diseases: an activity disease-related phenomenon? Dig Liver Dis 2006; 38:711-2. [PMID: 16782416 DOI: 10.1016/j.dld.2006.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Revised: 05/04/2006] [Accepted: 05/04/2006] [Indexed: 12/11/2022]
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20
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Abstract
Celiac disease is an immune mediated enteropathy initiated by ingestion of gluten, in genetically susceptible individuals. With changing epidemiology, celiac disease initially thought to affect only Europeans, has been increasingly reported from other parts of the world including India. However, its true prevalence in India is still not known, as the diagnosis is being missed. The gold standards for diagnosis have been characteristic small intestinal mucosal changes on gluten and a full clinical remission on its removal from the diet. Presence of serological antibodies, which disappear on gluten free diet further confirms the diagnosis. The understanding of the histopathology of celiac disease has changed over the years. The small bowel mucosal lesion of celiac disease is an evolutionary process with normal mucosal architecture and an increase in intraepithelial lymphocytes at one end of the spectrum and classical flat mucosa at the other. In the Indian subcontinent celiac disease has a heterogeneous histological presentation and the diagnosis may be missed if it is based only on severe mucosal changes or the serology is not considered when moderate or mild mucosal changes are present. The last two decades have shown that antiendomysical (Anti EMA) and anti tissue transglutaminase antibodies (anti-tTGA) have a sensitivity and specificity of more than 95% to diagnose celiac disease. Anti EMA tests being operator dependent are more liable to errors and anti- tTGA may be preferred for large scale screening. However, the different source of tTGA antigen, varied techniques of production and the use of arbitrary units by different commercial kits can influence the diagnostic accuracy of the anti-tTGA assay. There is a strong genetic association of celiac disease with HLA-DQ2 or DQ8. The presence of HLA-DQ2 hetrodimer in more than 97% of a group of North Indian patients with celiac disease indicates that this population has a similar genetic risk for the disease. HLA DQ2 typing can be used for ruling out celiac disease where the diagnosis is equivocal as it has a negative predictive value of greater than 95%. Given the protean clinical manifestation and the heterogeneous histology a standard algorithm for diagnosis of celiac disease is important.
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Affiliation(s)
- Shinjini Bhatnagar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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21
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Germenis AE, Yiannaki EE, Zachou K, Roka V, Barbanis S, Liaskos C, Adam K, Kapsoritakis AN, Potamianos S, Dalekos GN. Prevalence and clinical significance of immunoglobulin A antibodies against tissue transglutaminase in patients with diverse chronic liver diseases. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2005; 12:941-8. [PMID: 16085912 PMCID: PMC1182196 DOI: 10.1128/cdli.12.8.941-948.2005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The prevalence of celiac disease (CD) and the prevalence and clinical significance of anti-tissue transglutaminase (tTG) antibodies (tTGAbs) in a large series of patients with chronic liver diseases were assessed. We studied 738 patients (462 with chronic viral hepatitis, 117 with autoimmune liver diseases, 113 with alcoholic or nonalcoholic fatty liver disease, and 46 with other liver disorders) and 1,350 healthy controls (HC). Immunoglobulin A (IgA) tTGAbs were measured by enzyme-linked immunosorbent assay and a microsphere-based flow cytometric assay. Positive sera were investigated for IgA antiendomysial antibodies (EmA). IgA tTGAb-positive subjects were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Four of 1,350 HC (0.3%) tested tTGAb(+) EmA(+) and underwent a biopsy (CD confirmation in all). Four of 738 liver disease patients tested tTGAbs(+) EmA(+) (0.54%; not statistically significant). Two were HCV infected (1.24%; not statistically significant), and two had transaminasemia of unknown origin. Forty-three patients tested tTGAbs(+) EmA(-) (5.8%; P<0.001 compared to HC). Inhibition experiments verified the existence of specific IgA anti-tTG reactivity. Twenty-six of 43 patients underwent a biopsy (all negative for CD). Binary logistic regression analysis revealed age (P=0.008), cirrhosis (P=0.004), alkaline phosphatase (P=0.026), and antinuclear antibodies (P=0.012) as independent risk factors for tTGAb reactivity among the patients. It was concluded that CD prevalence is the same in HC and patients with chronic liver diseases. The prevalence of tTGAbs is higher in hepatic patients compared to HC, but their specificity for CD diagnosis in this group of patients is low. tTGAbs in patients appear to be associated with the presence of autoimmunity, cirrhosis, and cholestasis, irrespective of the origin of the liver disease.
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Affiliation(s)
- Anastasios E Germenis
- Laboratory of Immunology and Histocompatibility, University Hospital of Larissa, Larissa, Greece.
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22
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Lo Iacono O, Petta S, Venezia G, Di Marco V, Tarantino G, Barbaria F, Mineo C, De Lisi S, Almasio PL, Craxì A. Anti-tissue transglutaminase antibodies in patients with abnormal liver tests: is it always coeliac disease? Am J Gastroenterol 2005; 100:2472-7. [PMID: 16279902 DOI: 10.1111/j.1572-0241.2005.00244.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coeliac disease (CD) is found in 5-10% of patients with chronically abnormal liver tests and no obvious cause of liver disease. In this population the efficacy of screening for CD by anti-tissue transglutaminase (anti-tTG) may be impaired by the high rate of positive anti-tTG found in chronic liver disease. AIMS To evaluate the prevalence of coeliac disease and the role of anti-tTG in patients with non-viral, non-autoimmune chronic and no obvious cause of liver damage. METHODS Out of 2,512 consecutive patients with abnormal liver tests, 168 (118 men, 50 women; mean age 40.7 +/- 12.6 years) were defined, on the basis of clinical data and liver biopsy, as NAFLD or cryptogenic chronic hepatitis. All were tested by recombinant IgA and IgG anti-tissue transglutaminase. Patients with a positive serology underwent endoscopy with duodenal biopsies. RESULTS NAFLD was diagnosed in 121 patients, in 6 associated with cirrhosis, while 47 patients were considered as cryptogenic hepatitis in the absence of steatosis. Anti-tTG were positive in 20/168 patients (3 IgA alone; 11 IgG alone; 6 both IgA and IgG). Coeliac disease was found at endoscopy and confirmed by histopathology only in the 6 patients (3.6%) with both IgA and IgG anti-tTG positivity. Four of the patients with CD had NAFLD (3.3%), in 2 of them associated with cirrhosis; while 2 of those with cryptogenic hepatitis (4.2%) had CD. CONCLUSIONS The prevalence of CD in patients with chronically abnormal liver tests of unexplained etiology is 4%, with no relation with the degree of liver steatosis. Screening should be done by testing for IgA and IgG antibodies and then evaluating by endoscopy and biopsy only patients positive for both.
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Affiliation(s)
- Oreste Lo Iacono
- University of Palermo, Gastroenterology and Hepatology Unit, Palermo, Italy
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23
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Fabiani E, Peruzzi E, Mandolesi A, Garbuglia G, Fanciulli G, D'Appello AR, Gasparin M, Bravi E, Bearzi I, Galeazzi R, Catassi C. Anti-human versus anti-guinea pig tissue transglutaminase antibodies as the first-level serological screening test for coeliac disease in the general population. Dig Liver Dis 2004; 36:671-6. [PMID: 15506666 DOI: 10.1016/j.dld.2004.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND So far the reliability of the anti-guinea pig and anti-human tissue transglutaminase antibodies for the coeliac disease diagnosis has been evaluated in selected groups of patients. AIM To compare the diagnostic accuracy of anti-human versus anti-guinea pig tissue transglutaminase in the coeliac disease screening of the general population. SUBJECTS Two healthy Italian populations living in Marche region and in Western Sardinia. METHODS Both anti-guinea pig and anti-human tissue transglutaminase were determined using an enzyme-linked immunosorbent assay-based commercially available kit (Eu-tTG, Eurospital, Trieste, Italy). RESULTS During the period 1999-2001, 3541 subjects (1500 from "continental" Italy and 2041 from Sardinia) were screened for coeliac disease using both anti-guinea pig and anti-human tissue transglutaminase as first-level tests. Both these tests were negative in 3439/3541 sera, while 29 resulted positive for both of them and 73 showed discordant results. Overall, 50 intestinal biopsies were performed in 22, 21 and 7 subjects with positivity to both screening tests, to anti-guinea pig and to anti-human tissue transglutaminase alone, respectively. A coeliac disease diagnosis was made in 25 subjects giving an overall prevalence of 1:126 individuals. The anti-tissue transglutaminase specificity and sensitivity were 98 and 92% for guinea pig and 99.6 and 96% for human tissue transglutaminase, respectively. CONCLUSIONS The anti-human tissue transglutaminase test should definitely replace the anti-guinea pig-derived one as first-level screening tool for identifying all subjects who need the second-level investigations (small intestinal biopsy).
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Affiliation(s)
- E Fabiani
- Department of Pediatrics, University of Ancona, Via F. Corridoni no. 11, 60123 Ancona, Italy
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Di Tola M, Sabbatella L, Anania MC, Viscido A, Caprilli R, Pica R, Paoluzi P, Picarelli A. Anti-tissue transglutaminase antibodies in inflammatory bowel disease: new evidence. ACTA ACUST UNITED AC 2004; 42:1092-7. [PMID: 15552265 DOI: 10.1515/cclm.2004.225] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractAnti-tissue transglutaminase, previously held to be identical to anti-endomysial antibodies in celiac sprue, has been reported in inflammatory bowel disease patients. To investigate these data further, we evaluated serum and intestinal anti-tissue transglutaminase in inflammatory bowel disease patients, with respect to the Crohn’s disease activity index and the integrated disease activity index. Study population comprised: 49 patients with Crohn’s disease and 29 patients with ulcerative colitis; 45 patients with celiac sprue and 85 autoimmune patients as disease controls; and 58 volunteers as healthy controls. Immunoglobulin A (IgA) anti-recombinant human tissue transglutaminase and anti-endomysial antibody detection in sera and fecal supernatants were performed. Adsorption of positive sera with recombinant human tissue transglutaminase were also performed. Marked increased anti-tissue transglutaminase concentrations were found in celiac sprue, while low-positive values were also found in Crohn’s disease and ulcerative colitis. Anti-endomysial antibodies were detectable only in celiac sprue. Antigen adsorption resulted in a significant reduction of the anti-tissue transglutaminase either in celiac sprue or inflammatory bowel disease sera. A significant correlation between anti-tissue transglutaminase and Crohn’s disease activity index or integrated disease activity index scores was found. Anti-tissue transglutaminase was also detectable in fecal supernatants from inflammatory bowel disease patients. Data highlight that both circulating and intestinal anti-tissue transglutaminases are detectable in inflammatory bowel disease, and that they are related to disease activity. These features underline that, in addition to anti-tissue transglutaminase, an anti-endomysial antibody test is necessary in the diagnostic work-up of celiac sprue, especially in patients with known inflammatory bowel disease.
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Affiliation(s)
- Marco Di Tola
- Department of Clinical Sciences, University La Sapienza, Rome, Italy
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Picarelli A, Di Tola M, Sabbatella L, Vetrano S, Anania MC, Spadaro A, Sorgi ML, Taccari E. Anti-tissue transglutaminase antibodies in arthritic patients: a disease-specific finding? Clin Chem 2003; 49:2091-4. [PMID: 14633886 DOI: 10.1373/clinchem.2003.023234] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Picarelli
- Gastroenterological Unit, Department of Clinical Sciences, University "La Sapienza", Rome, Italy.
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Orrù S, Caputo I, D'Amato A, Ruoppolo M, Esposito C. Proteomics identification of acyl-acceptor and acyl-donor substrates for transglutaminase in a human intestinal epithelial cell line. Implications for celiac disease. J Biol Chem 2003; 278:31766-73. [PMID: 12799366 DOI: 10.1074/jbc.m305080200] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Transglutaminase (TG)-catalyzed cross-linking of both intracellular and extracellular proteins is an important biochemical event. However, increased concentrations of cross-linked proteins have been observed in many disorders. Moreover, TG-catalyzed modification of proteins might generate new self-antigens responsible for the autoimmune response, as in celiac disease. The identification of available substrates may offer an understanding of how the TG-catalyzed post-translational modification has an impact on physiology and disease. We used a proteomic approach to identify TG-modified protein targets in human intestinal epithelial cells to determine the extent to which transglutaminase specifically contributes to celiac disease. Two probes were used for endogenous TG activity: 5-(biotinamido)pentylamine, which represents the acyl-acceptor, and a biotinylated glutamine-containing peptide, which represents the acyl-donor. This approach identified >25 proteins, which range from 30,000 to 300,000 Daltons and can serve as acyl-acceptor and/or acyl-donor for transglutaminase. Some of them were known transglutaminase substrates, whereas others had not been previously identified. These targets include proteins involved in cytoskeletal network organization, folding of proteins, transport processes, and miscellaneous metabolic functions.
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Affiliation(s)
- Stefania Orrù
- Department of Chemistry, University of Salerno, 84081 Baronissi, Salerno, Italy
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Esposito C, Paparo F, Caputo I, Porta R, Salvati VM, Mazzarella G, Auricchio S, Troncone R. Expression and enzymatic activity of small intestinal tissue transglutaminase in celiac disease. Am J Gastroenterol 2003; 98:1813-20. [PMID: 12907337 DOI: 10.1111/j.1572-0241.2003.07582.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The molecular and functional properties of small intestinal tissue transglutaminase are largely unknown despite growing interest because of its role in celiac disease (CD). In this study, we aimed to evaluate tissue transglutaminase expression and enzymatic activity in bioptic fragments obtained from the duodenum of untreated individuals with CD and from control subjects. METHODS Analysis of tissue transglutaminase mRNA expression was performed by reverse transcription-polymerase chain reaction (RT-PCR). The presence of the enzyme in bioptic fragments as well as in homogenates from CD patients and controls was revealed by immunohistochemistry and Western blot, respectively, using the antitissue transglutaminase CUB 7402 clone. To evaluate in situ transglutaminase activity, sections of bioptic fragments were incubated in the presence of 5 mmol/L CaCl(2) with 5-(biotinamido)pentylamine or, alternatively, with a biotinylated glutamine-containing hexapeptide (TVQQEL) and the biotinylated 31-43 A-gliadin-derived peptide. RESULTS Tissue transglutaminase mRNA levels were 1.0-fold higher (p < 0.05) in CD patients than in controls. Immunohistochemistry and in situ demonstration of enzymatic activity in celiac mucosa clearly showed an increased expression of active tissue transglutaminase in the extracellular matrix of the subepithelial region and in the enterocytes. Staining of the biotinylated 31-43 A-gliadin peptide in the same area of tissue transglutaminase suggested the presence of lysine-donor substrates in intestinal mucosa. CONCLUSIONS Tissue transglutaminase is more expressed and active in defined areas of the small intestinal mucosa from patients with CD. The presence in the celiac mucosa of proteins able to act as amine-donor substrates suggests that tissue transglutaminase-mediated post-translational modification of proteins cross-linked with gliadin peptides may represent a pathogenic mechanism of CD.
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Affiliation(s)
- Carla Esposito
- Department of Chemistry, University of Salerno, Salerno, Italy
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Ehrmann J, Kolek A, Kod'ousek R, Zapletalová J, Lísová S, Murray PG, Drábek J, Kolár Z. Immunohistochemical study of the apoptotic mechanisms in the intestinal mucosa during children's coeliac disease. Virchows Arch 2003; 442:453-61. [PMID: 12698366 DOI: 10.1007/s00428-003-0794-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Accepted: 02/12/2003] [Indexed: 10/25/2022]
Abstract
Mechanisms leading to morphological changes of the small intestine during coeliac disease (CD) are not yet completely recognized; however, two main processes have been suggested recently: remodeling of mucosa by matrix metalloproteinases, and mucosal atrophy by apoptosis. The aim of this study was analysis of the expression of proteins regulating apoptosis in the small intestine of children with active CD (ACD) and potential CD (PCD). Jejunal biopsies of 43 children with PCD and untreated ACD and 21 control samples were analyzed by means of standard indirect immunohistochemical technique for Fas, Fas ligand (Fas-L), tissue transglutaminase (tTG), Bcl-2, and glutathione S-transferase (GST) expression. We found significantly lower numbers of Fas-expressing enterocytes in the ACD patients than in PCD patients and controls. Similarly, the number of Fas-positive mucosal lymphocytes was decreased in ACD when compared with PCD. The number of Fas-L- and tTG-expressing enterocytes and mucosal lymphocytes was higher in both PCD and ACD. On the other hand, the number of Bcl-2-positive mucosal lymphocytes in PCD as well as ACD was significantly lower. The expression of tTG in extracellular matrix was significantly higher in PCD and ACD when compared with controls. Our results showed that Fas and/or Fas-L, Bcl-2, and tTG may be involved in apoptotic pathways leading to mucosal atrophy in children with CD. tTG changes are in agreement with the presumed role of this protein in the pathogenesis of CD.
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Affiliation(s)
- Jirí Ehrmann
- Laboratory of Molecular Pathology & Institute of Pathology, Palacký University, Hnevotínská 3 77515, Olomouc, Czech Republic
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Peracchi M, Trovato C, Longhi M, Gasparin M, Conte D, Tarantino C, Prati D, Bardella MT. Tissue transglutaminase antibodies in patients with end-stage heart failure. Am J Gastroenterol 2002; 97:2850-4. [PMID: 12425559 DOI: 10.1111/j.1572-0241.2002.07033.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For celiac disease (CD), screening a trend has recently emerged to measure tissue transglutaminase antibodies (tTGA) by immunoassays instead of the more laborious endomysial antibodies (EmA), as they recognize the same target, tissue transglutaminase (tTG). However, a high rate of false-positive results has been reported in some patient series with diseases known to be associated with CD. Moreover, tTG is a ubiquitous, multifunctional enzyme, overexpressed in experimental models of heart failure. Therefore, we assessed the specificity of tTGA assays in a large series of EmA-negative patients with end-stage heart failure. METHODS We studied 288 patients with end-stage heart failure and 60 blood donors. No subject had clinical evidence of CD or IgA deficiency, and all were EmA negative. Serum IgA and IgG tTGA were measured by means of commercial kits using as substrate, either guinea pig or recombinant human tTG. Blocking studies and Western blots were also performed using recombinant human tTG. RESULTS All blood donor sera were IgA tTGA negative. IgA tTGA positivity was observed in 47.6% and 49.1% of patients with heart failure using, respectively, guinea pig tTG and recombinant human tTG as substrates. Preincubation of positive sera with recombinant human tTG resulted in 81% blocking of IgA tTGA in immunoassay. Western blot analysis confirmed the presence of antibodies against recombinant human tTG. IgA tTGA-positive sera were also IgG tTGA positive. CONCLUSIONS IgA and IgG tTGA occur in a large number of EmA-negative patients with end-stage heart failure, and their presence is unlikely to be caused by concomitant CD.
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Di Tola M, Sabbatella L, Picarelli A. Presence of AntiTissue Transglutaminase Antibodies as a Sign of Tissue Lesion. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Marco Di Tola
- Department of Clinical Sciences, University of Rome “La Sapienza”, 155-00161 Rome, Italy
| | - Luigi Sabbatella
- Department of Clinical Sciences, University of Rome “La Sapienza”, 155-00161 Rome, Italy
| | - Antonio Picarelli
- Department of Clinical Sciences, University of Rome “La Sapienza”, 155-00161 Rome, Italy
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