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Lupu VV, Sasaran MO, Jechel E, Starcea IM, Ioniuc I, Mocanu A, Rosu ST, Munteanu V, Nedelcu AH, Danielescu C, Salaru DL, Knieling A, Lupu A. Celiac disease - a pluripathological model in pediatric practice. Front Immunol 2024; 15:1390755. [PMID: 38715620 PMCID: PMC11074362 DOI: 10.3389/fimmu.2024.1390755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/03/2024] [Indexed: 05/23/2024] Open
Abstract
Being defined as an autoimmune, chronic pathology, frequently encountered in any age group, but especially in pediatrics, celiac disease (also called gluten enteropathy), is gaining more and more ground in terms of diagnosis, but also interest in research. The data from the literature of the last decades attest the chameleonic way of its presentation, there may be both classic onset symptoms and atypical symptoms. Given the impact played by celiac disease, especially in the optimal growth and development of children, the current narrative review aims to highlight the atypical presentation methods, intended to guide the clinician towards the inclusion of the pathology in the differential diagnosis scheme. To these we add the summary presentation of the general data and therapeutic lines regarding the underlying condition and the existing comorbidities. In order to place the related information up to date, we performed a literature review of the recent articles published in international databases. We bring forward the current theories and approaches regarding both classic celiac disease and its atypical manifestations. Among these we note mainly constitutional, skin or mucous, bone, neuro-psychic, renal, reproductive injuries, but also disorders of biological constants and association with multiple autoimmunities. Knowing and correlating them with celiac disease is the key to optimal management of patients, thus reducing the subsequent burden of the disease.
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Affiliation(s)
- Vasile Valeriu Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Maria Oana Sasaran
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Elena Jechel
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Ileana Ioniuc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Adriana Mocanu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Solange Tamara Rosu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Valentin Munteanu
- Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Alin Horatiu Nedelcu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ciprian Danielescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Anton Knieling
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ancuta Lupu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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Gong C, Saborit C, Long X, Wang A, Zheng B, Chung H, Lewis SK, Krishnareddy S, Bhagat G, Green PH, Kong XF. Serological Investigation of Persistent Villous Atrophy in Celiac Disease. Clin Transl Gastroenterol 2023; 14:e00639. [PMID: 37753949 PMCID: PMC10749705 DOI: 10.14309/ctg.0000000000000639] [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] [Received: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Persistent villous atrophy (VA) is not uncommon in celiac disease (CeD) while patients take a gluten-free diet (GFD). METHODS We conducted a retrospective study with 122 serum samples collected from controls and patients with CeD either at the initial diagnosis or at the follow-up during endoscopy. These samples were assigned to 3 groups: nonceliac control, non-VA CeD (Marsh score 0-2), and VA CeD (Marsh score 3a-3c). We established an in-house multiplex assay to identify potential serological biomarkers for VA. We assessed autoantibodies reported to affect the small intestine, including IgA and IgG antibodies against tissue transglutaminase (tTG), interferons, villin, actin, autoimmune enteropathy-related 75 kDa antigen (AIE-75), and tryptophan hydroxylase (TPH)-1, as well as 27 cytokines. The apolipoproteins quantified included apo A1, apo B-100, and apo A4, which were produced predominantly by the intestinal epithelium or expressed specifically in villi. RESULTS Autoantibody levels were high only for tTG antibodies, which performed well in initial CeD diagnosis, but suboptimally for VA prediction during follow-up, because 14.6% of the follow-up patients with VA had low tTG-IgA. Increasing dilution improved tTG-IgA quantification, particularly when the antibody levels were extremely high but did not significantly improve VA detection. Among those with low tTG-IgA and persistent VA, high proinflammatory cytokines were observed in 2 patients. Median low-density lipoprotein cholesterol levels were significantly lower in the VA CeD group ( P = 0.03). Apolipoprotein levels were similar in patients with and without VA but diverged between those on a GFD or not. DISCUSSION tTG-IgA as a biomarker is suboptimal for VA prediction while on a GFD. Persistent VA is associated with low low-density lipoprotein cholesterol levels and partially related to persistent high proinflammatory cytokines.
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Affiliation(s)
- Changlin Gong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Claudia Saborit
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Xin Long
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ao Wang
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Beishi Zheng
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Howard Chung
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suzanne K. Lewis
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Suneeta Krishnareddy
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Govind Bhagat
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Pathology and Cell Biology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Peter H.R. Green
- Department of Medicine, Celiac Disease Center, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Xiao-Fei Kong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas, USA
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Personalised Nutritional Plan and Resistance Exercise Program to Improve Health Parameters in Celiac Women. Foods 2022. [PMCID: PMC9601757 DOI: 10.3390/foods11203238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Celiac disease (CD) is a permanent immune reaction to gluten in those with a genetic predisposition. This study was designed to evaluate menopause-associated symptoms, mood, bone quality, and IgA antibody levels in women with CD, untreated and treated with a gluten-free diet (GFD), and with or without resistance exercise. The randomised controlled trial was conducted on 28 Spanish women (>40 years old). Participants were divided into the following intervention groups: personalised gluten-free nutrition plan + exercise (GFD + E); personalised gluten-free nutrition plan (GFD); celiac controls (NO-GFD); and non-celiac controls (CONTROL). The participants responded to the Menopause Rating Scale and the Profile of Mood States (POMS) questionnaires. Bone quality was measured with ultrasound and IgA with a blood test. After 12 weeks of intervention, the GFD + E group showed significant improvement in urogenital symptoms and scored higher on the ‘vigour’ subscale of the POMS. Negative associations were found between the total score on the Menopause Rating Scale and the ‘vigour’ subscale of the POMS questionnaire. Only those women who underwent a personalised GFD nutritional intervention combined with resistance exercise demonstrated significant changes after the intervention.
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Gudeta AN, Andrén Aronsson C, Binagdie BB, Girma A, Agardh D. Incidence of celiac disease autoimmunity and associations with maternal tuberculosis and pediatric Helicobacter pylori infections in 4-year-old Ethiopian children followed up in an HLA genotyped birth cohort. Front Pediatr 2022; 10:999287. [PMID: 36389354 PMCID: PMC9644195 DOI: 10.3389/fped.2022.999287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/28/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of celiac disease in the general population is mainly unknown in most of sub-Saharan African countries. The aim of this study was to determine the incidence of celiac disease autoimmunity (CDA) and its associations with latent Mycobacterium tuberculosis (LMTB) and Helicobacter pylori (HP) infections in Ethiopian children aged 4 years in an HLA genotyped cohort study. METHODS Of 1,389 recruited children between 2018 and 2022, 1,046 (75.3%) had been screened at least twice for celiac disease between the ages of 2 and 4 years using a tissue transglutaminase autoantibody (tTGA) ELISA kit. Tissue TGA-positive children were retested using radio-binding assays. CDA was defined as persistent-confirmed tTGA positivity in two consecutive samples. Associations of CDA with LMTB and HP were tested in a subpopulation of 752 children born to mothers who were previously tested for LMTB with IFN-γ and anti-HP antibodies in samples collected at a mean age of 49.3 ± 5.3 months. RESULTS Screening detected 38 out of 1,046 (3.6%) IgA-tTGA-positive children. Ten (1.0%) were confirmed to be positive, with six (0.6%) children diagnosed with CDA. The incidence of CDA at 4 years of age was 1.2 per 1,000 person-years. LMTB was found in 4 of 6 (66.7%) mothers with CDA children compared with 340 of 734 (46.3%) mothers of children without CDA (p = 0.424), while HP was found in 3 of 6 (50.0%) CDA children compared with 315 of 746 (42.2%) children without CDA (p = 0.702). CONCLUSION The incidence of CDA in Ethiopian children is lower than the pooled global incidence. Neither LMTB nor HP infections are associated with CD in Ethiopian children.
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Affiliation(s)
- Adugna Negussie Gudeta
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Carin Andrén Aronsson
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | | | - Alemayehu Girma
- Department of Pediatrics, Adama Hospital Medical College, Adama, Ethiopia
| | - Daniel Agardh
- Unit of Diabetes and Celiac Disease, Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
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