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Magazzù G, Aquilina S, Barbara C, Bondin R, Brusca I, Bugeja J, Camilleri M, Cascio D, Costa S, Cuzzupè C, Duca A, Fregapane M, Gentile V, Giuliano A, Grifò A, Grima AM, Ieni A, Li Calzi G, Maisano F, Melita G, Pallio S, Panasiti I, Pellegrino S, Romano C, Sorce S, Tabacchi ME, Taormina V, Tegolo D, Tortora A, Valenti C, Vella C, Raso G. Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project-Global Strategy Protocol. Pediatr Rep 2022; 14:293-311. [PMID: 35736659 PMCID: PMC9227897 DOI: 10.3390/pediatric14020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the "coeliac iceberg" in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support.
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Affiliation(s)
- Giuseppe Magazzù
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
- Correspondence:
| | - Samuel Aquilina
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Christopher Barbara
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Ramon Bondin
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Ignazio Brusca
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | | | - Mark Camilleri
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Donato Cascio
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Stefano Costa
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Chiara Cuzzupè
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Annalise Duca
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Maria Fregapane
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | - Vito Gentile
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Angele Giuliano
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Alessia Grifò
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Anne-Marie Grima
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giada Li Calzi
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Fabiana Maisano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giuseppinella Melita
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Socrate Pallio
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy;
| | - Ilenia Panasiti
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Pellegrino
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Claudio Romano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Sorce
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Marco Elio Tabacchi
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Vincenzo Taormina
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Domenico Tegolo
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Andrea Tortora
- DAI Scienze Mediche, AOU Policlinico G. Martino, 98124 Messina, Italy;
| | - Cesare Valenti
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Cecil Vella
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Giuseppe Raso
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
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Slavin SF. IgA Nephropathy as the Initial Presentation of Celiac Disease in an Adolescent. Pediatrics 2021; 148:peds.2021-051332. [PMID: 34504037 DOI: 10.1542/peds.2021-051332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
Immunoglobulin A (IgA) nephropathy (Berger's disease) is the most common glomerulonephritis worldwide. The disease typically is chronic and lifelong and eventually progresses to impaired renal function in a substantial proportion of cases. It has been known for some time that there is a correlation between IgA nephropathy and celiac disease, but until now it has remained unclear whether treatment of the underlying celiac disease has any meaningful impact on the progression of the renal disease. Therefore, until now, screening for celiac disease in patients presenting with IgA nephropathy has not been universally recommended in the absence of suggestive gastrointestinal symptoms. This report describes a case of IgA nephropathy in an adolescent boy that turned out to be the initial presentation of celiac disease. More importantly, it documents the complete laboratory normalization of his renal anomalies at 5-year follow-up after treatment of his celiac disease with implementation of a gluten-free diet. This case highlights the importance of awareness that suspected IgA nephropathy, even in the absence of gastrointestinal symptoms, should prompt screening for underlying celiac disease as a potential, and possibly treatable, cause.
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Celiac Disease-Type Tissue Transglutaminase Autoantibody Deposits in Kidney Biopsies of Patients with IgA Nephropathy. Nutrients 2021; 13:nu13051594. [PMID: 34064541 PMCID: PMC8150858 DOI: 10.3390/nu13051594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 01/07/2023] Open
Abstract
An association between celiac disease and IgA nephropathy (IgAN) has been suggested. In celiac disease, in addition to circulating in serum, IgA-class tissue transglutaminase (tTG) autoantibodies are deposited in the small bowel mucosa and extraintestinal organs. In this case series of IgAN patients with or without celiac disease, we studied whether celiac disease-type IgA-tTG deposits occur in kidney biopsies. The study included nine IgAN patients, four of them with celiac disease. At the time of the diagnostic kidney biopsy serum tTG autoantibodies were measured and colocalization of IgA and tTG was investigated in the frozen kidney biopsies. Three IgAN patients with celiac disease had IgA-tTG deposits in the kidney even though in two of these the celiac disease diagnosis had been set years later. These deposits were not found in a patient with already diagnosed celiac disease following a gluten-free diet. Of the five non-celiac IgAN patients, three had IgA-tTG deposits in the kidney. We conclude that tTG-targeted IgA deposits can be found in the kidney biopsies of gluten-consuming IgAN patients but their specificity to celiac disease seems limited.
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Abbad L, Monteiro RC, Berthelot L. Food antigens and Transglutaminase 2 in IgA nephropathy: Molecular links between gut and kidney. Mol Immunol 2020; 121:1-6. [PMID: 32135400 DOI: 10.1016/j.molimm.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 01/27/2023]
Abstract
The transglutaminase 2 (TG2) is one of the enigmatic enzymes with important functional diversity. It plays an important role in several pathologies such as celiac disease (CD). In patients with active CD, the abnormal retrotranscytosis of IgA/gliadin complexes is mediated by Transferrin Receptor 1 (TfR1). This triad association takes also place in IgA nephropathy (IgA-N). IgA-N is characterized by the formation of nephrotoxic complexes of IgA1 and soluble CD89 (sCD89). These complexes are abnormally deposited in the kidney. Using a humanized mouse model of IgA-N (α1KI-CD89Tg), we showed that IgA1-sCD89 complexes engender mesangial cell activation and proliferation with TfR1 and TG2 up-regulation, associated with IgA-N features. This TG2-TfR1 interaction enhances mesangial IgA1 deposition promoting inflammation. Humanized α1KI-CD89Tg mice deficient for TG2 show a decrease in TfR1 expression in kidney leading to reduced IgA1-sCD89 deposits and an improvement in IgA-N features. Moreover, TG2 is active and overexpressed in the intestine of IgA-N mice and gliadin participates to this renal pathology. In kidney as in intestine, the TG2 has a crucial role in the cooperation between TfR1-IgA and a central role in the pathogenic amplification.
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Affiliation(s)
- Lilia Abbad
- INSERM UMR1149, Center of Research on Inflammation CRI, CNRS ERL8252, Paris, France; Inflamex Laboratory of Excellence, Paris Diderot University, Sorbonne Paris City, Paris, France
| | - Renato C Monteiro
- INSERM UMR1149, Center of Research on Inflammation CRI, CNRS ERL8252, Paris, France; Inflamex Laboratory of Excellence, Paris Diderot University, Sorbonne Paris City, Paris, France; Immunology Department, AP-HP, DHU Fire, Paris, France
| | - Laureline Berthelot
- Centre de Recherche en Transplantation et Immunologie, Nantes, UMR1064, INSERM, Université de Nantes, France; Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, Nantes, France; LabEx IGO, "Immunotherapy, Graft, Oncology", Nantes, France.
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