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Anti-microbial antibodies in celiac disease:Trick or treat?

World Journal of Gastroenterology 2009年第31期15卷 3891-3900页

作者： Maria Papp Ildiko Foldi Istvan Altorjay Eszter Palyu Miklos Udvardy Judit Tumpek sandor sipka Ilma Rita Korponay-Szabo Eva Nemes Gabor Veres Tamas Dinya Attila Tordai Hajnalka Andrikovics Gary L Norman Peter Laszlo Lakatos 2nd Department of Medicine University of Debrecen Laboratory of Clinical Immunology University of Debrecen Department of Pediatrics University of DebrecenDebrecenH-4032HungaryIlma Rita Korponay-SzaboCeliac Disease CenterHeim Pal Children's Hospital 1st Department of Pediatrics Semmelweis University Institute of Surgery University of Debrecen Department of Molecular Diagnostics Hungarian National Blood Transfusion Service INOVA Diagnostics Inc. 1st Department of Medicine Semmelweis University

AIM： To determine the prevalence of a new set ot anti-glycan and anti-outer membrane protein （anti- OMP） antibodies in a Hungarian cohort of adult Celiac disease （CD） patients. METHODS： 190 consecutive CD patients [M/F： 71/119, age：39.9 （SD：14.1） years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae （gASCA）, anti-laminaribioside （ALCA）, anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet （GFD）. RESULTS： 65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, antimicrobial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity （LR＋： 3.13; 95% CI： 2.08-4.73） was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis （P = 0.019）. CONCLUSION： The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.

关键词： Celiac disease Glycans Anti-Saccharomyces cerevisiae antibodies Anti-outer membrane protein antibody NOD2/CARD15 Gluten-free diet Presenting symptoms Bacterial translocation Crohn's disease

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