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Serological Responses to Microbial Antigens in Celiac Disease Patients During a Gluten-Free Diet

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Abstract

Background

Immunoglobulin A (IgA) autoantibodies to tissue transglutaminase (tTG) are commonly used for screening and diagnosing of celiac disease (CD). Seroreactivity for anti-Saccharomyces cerevisiae antibody (ASCA) and bacterial antigens have also been detected in CD patients. The aim of this study was to examine prospectively serologic responses to microbial targets in adult CD patients at the time of diagnosis and during a gluten-free diet (GFD). Further, we wanted to evaluate whether these serologic specificities could provide new tools for the follow-up of CD patients.

Methods

Data on 55 adult biopsy-proven CD patients were available for follow-up study. Upper gastrointestinal endoscopy was performed on all patients. Sera from patients were tested for antibodies to tTG and ASCA and additionally analyzed with IgA enzyme-linked immunosorbent assays to Pseudomonas fluorescens-associated sequence, I2, and to a Bacteroides caccae TonB-linked outer membrane protein, OmpW.

Results

At the time of diagnosis, 91% of CD cases were positive for tTG and 49% for ASCA; positive seroreactivity to I2 was found in 86% and to OmpW in 60% of CD patients at the time of diagnosis. The frequency of seropositivity and serum levels of these antibodies decreased during GFD. Moreover, we found that the decline in the serum levels was significant in all of these markers (p < 0.005). Interestingly, we also found that serum levels of ASCA correlated with the grade of mucosal morphology (p = 0.021), as the ASCA serum levels declined in accordance with mucosal healing.

Conclusions

Commensal enteric bacteria seem to play a role in the small intestinal mucosal damage in CD. This was proven by the serological responses to different microbial antigens shown in this study. Serum levels of ASCA, anti-I2, and anti-OmpW antibodies decreased significantly during GFD, indicating that these serologic markers are gluten dependent in CD patients. These specificities could provide new tools in the follow-up of CD patients.

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Acknowledgments

This study was supported by grants from the Paediatric Research Foundation, The Competitive Research Funding of the Pirkanmaa Hospital District, and NIH PO1-DK 46763 (J.B.). The authors would like to acknowledge Ms Leena Ripsaluoma for excellent assistance in recruitment of the patients and Ms Kaija Laurila and Ms Marja-Leena Koskinen for technical support.

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Authors and Affiliations

  1. Paediatric Research Centre and Medical School, University of Tampere and Tampere University Hospital, Tampere, Finland

    Sara Ashorn, Katri Kaukinen, Merja Ashorn, Markku Mäki & Sari Iltanen

  2. Institute of Medical Technology, University of Tampere, Tampere, Finland

    Tuuli Välineva

  3. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

    Katri Kaukinen & Pekka Collin

  4. Department of Paediatrics, Tampere University Hospital, Tampere, Finland

    Merja Ashorn & Markku Mäki

  5. Department of Microbiology, Tampere University Hospital, Tampere, Finland

    Hanna Raukola

  6. Department of Pathology, Tampere University Hospital, Tampere, Finland

    Immo Rantala

  7. Science Center, Pirkanmaa University Hospital District, Tampere, Finland

    Tiina Luukkaala

  8. Tampere School of Public Health, University of Tampere, Tampere, Finland

    Tiina Luukkaala

  9. Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA

    Jonathan Braun

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  1. Sara Ashorn
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Correspondence to Sari Iltanen.

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Ashorn, S., Välineva, T., Kaukinen, K. et al. Serological Responses to Microbial Antigens in Celiac Disease Patients During a Gluten-Free Diet. J Clin Immunol 29, 190–195 (2009). https://doi.org/10.1007/s10875-008-9255-7

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  • DOI: https://doi.org/10.1007/s10875-008-9255-7

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