Abstract
Immunoglobulin G antibodies against deamidated gliadin peptides are now known to have diagnostic accuracy comparable to tissue transglutaminase and endomysium autoantibodies in patients with coeliac disease. However, little is known about their predictive value in infants with a suspected gluten enteropathy. We tested whether deamidated gliadin immunoglobulin G antibodies are more reliable than traditional tests for coeliac disease screening in infancy. Sixty-five children under 2 years of age (42 with malabsorption, 23 controls) were tested for deamidated gliadin immunoglobulin G, tissue transglutaminase and endomysium immunoglobulin A, and gliadin immunoglobulins A and G . Thirty-seven of the 42 children with malabsorption had deamidated gliadin antibodies, associated with tissue transglutaminase and endomysial antibodies in 33, and with gliadin immunoglobulins A and G in 21 and 29, respectively. Intestinal biopsy was performed in 34 of the 37 children positive for deamidated gliadin antibodies. Thirty-two/34 showed villous atrophy consistent with coeliac disease, while the remaining two had a Marsh 1 and a normal mucosa, respectively. Only gliadin immunoglobulins A (4.3 %) and G (39.1 %) were found in controls. The sensitivity of deamidated gliadin, tissue transglutaminase and endomysial antibodies for coeliac disease was significantly higher than that of gliadin immunoglobulins G and A. High titre deamidated gliadin antibodies correlated with severe intestinal damage. Deamidated gliadin antibodies showed a higher diagnostic accuracy for coeliac disease than gliadin antibodies in infancy. High titre deamidated gliadin antibodies predict a severe gluten-dependent duodenal damage.
References
Di Sabatino A, Corazza GR. Coeliac disease. Lancet. 2009;373:1480–93.
Volta U, Villanacci V. Celiac disease:diagnostic criteria in progress. Cell Mol Immunol. 2011;8:96–102.
Sugai E, Vazquez H, Nachman F, et al. Accuracy of testing for antibodies to synthetic gliadin-related peptidesin celiac disease. Clin Gastroenetrol Hepatol. 2006;4:1112–7.
Agardh D. Antibodies against synthetic deamidated gliadin peptides and tissue transglutaminase for the identification of chidhood celiac disease. Clin Gastroenterol Hepatol. 2007;5:1276–81.
Kaulinen K, Collin P, Laurila K, et al. Resurrection of gliadin antibodies in celiac disease. Deamidated gliadin peptide antibody test provides additional diagnostic benefit. Scand J Gastroenterol. 2007;42:1428–33.
Niveloni S, Sugai E, Cabanne E, et al. Antibodies against synthetic deamidated gliadin peptides as predictors of celiac disease: prospective assessment in an adult population with a high pretest probabbility of disease. Clin Chem. 2007;53:2186–92.
Volta U, Granito A, Fiorini E, et al. Usefulness of antibodies to deamidated gliadin peptides in celiac disease diagnosis and follow-up. Dig Dis Sci. 2008;53:1582–8.
Mozo L, Gómez J, Escanlar E, Bousoño C, Gutiérrez C. Diagnostic value of anti-deamidated gliadin peptide IgG antibodies for celiac disease in children and IgA deficient patients. J Pediatr Gastroeneterol Nutr. 2012;55:50–5.
Lagerqvist C, Dahlbom I, Hansson T, et al. Antigliadin immunoglobulin A best in finding celiac disease in children younger than 18 months of age. J Pediatr Gastroenterol Nutr. 2008;47:428–35.
Volta U, Fabbri A, Parisi C, et al. Old and new serological tests for celiac disease screening. Expert Rev Gastroenterol Hepatol. 2010;4:31–5.
Troncone R, Ferguson A. Anti-gliadin antibodies. J Pediatr Gastroenterol Nutr. 1991;12:150–8.
Basso D, Guariso G, Fogar P, et al. Antibodies against synthetic deamidated gliadin peptides for celiac disease diagnosis and follow-up in children. Clin Chem. 2009;55:150–7.
Mubarak A, Gmelig-Meyling FHJ, Wolters VM, et al. Immunoglobulin G antibodies against deamidated-gliadin-peptides outperform anti-endomysium and tissue transglutaminase antibodies in children < 2 years age. APMIS. 2011;119:894–900.
Liu E, Li M, Emery L, et al. Natural history of antibodies to deamidated gliadin peptides and transglutaminase in early childhood celiac disease. J Pediatr Gastroenterol Nutr. 2007;45:293–300.
Barbato M, Maiella G, Di Camillo C, et al. The anti-deamidated gliadin peptide antibodies unmask celiac disease in small children with chronic diarrhoea. Dig Liver Dis. 2011;43:465–9.
Hyman PE, Milla PJ, Benninga MA, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130:1519–26.
Volta U, Granito A, Parisi C, et al. Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. J Clin Gastroenterol. 2011;44:186–90.
Oberhüber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–94.
Husby S, Koletzko S, Korponay-Szabò IR, et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60.
Acknowledgments
The present work was supported by grants from the Italian Ministry of Education, University and Research (MIUR) (PRIN2009) (R. De G.), ‘Fondazione Del Monte di Bologna e Ravenna’, Italy and funds from the University of Bologna (R. De G.). We wish to thank Prof. Kerry Rhoden for insightful comments and editing the manuscript.
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The authors declare no competing financial interests.
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Amarri, S., Alvisi, P., De Giorgio, R. et al. Antibodies to Deamidated Gliadin Peptides: An Accurate Predictor of Coeliac Disease in Infancy. J Clin Immunol 33, 1027–1030 (2013). https://doi.org/10.1007/s10875-013-9888-z
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DOI: https://doi.org/10.1007/s10875-013-9888-z