Liisa Viitasalo1,2, Kalle Kurppa3, Merja Ashorn1, Päivi Saavalainen4, Heini Huhtala5, Sara Ashorn1, Markku Mäki1, Tuire Ilus6, Katri Kaukinen7,8, Sari Iltanen1,9. 1. Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Arvo Ylpön katu 34, 33014, Tampere, Finland. 2. Department of Clinical Genetics and Laboratory of Genetics, HUSLAB, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland. 3. Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Arvo Ylpön katu 34, 33014, Tampere, Finland. kalle.kurppa@uta.fi. 4. Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, P.O. Box 21, Haartmaninkatu 3, 00014, Helsinki, Finland. 5. Faculty of Social Sciences, University of Tampere, P.O. Box 100, 33014, Tampere, Finland. 6. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland. 7. Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, P.O. Box 100, 33014, Tampere, Finland. 8. Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland. 9. Lapland Central Hospital, P.O. Box 8041, 96101, Rovaniemi, Finland.
Abstract
BACKGROUND AND AIMS: In nonresponsive celiac disease (NRCD), the symptoms and duodenal damage persist despite a gluten-free diet. Celiac disease patients with persistent symptoms are found to have a dysbiotic microbiota. We thus hypothesized that increased seroreactivity to the serum gluten-sensitive microbial antibodies Saccharomyces cerevisiae (ASCA), Pseudomonas fluorescens-associated sequence (I2), and Bacteroides caccae TonB-linked outer membrane protein (OmpW) is associated with NRCD. METHODS: ASCA, I2 and OmpW were measured in 20 seronegative CD patients with persistent villous damage despite strict dietary treatment (NRCD group). Fifty-eight responsive patients served as CD controls (55 on gluten-free treatment) and 80 blood donors as non-CD controls. RESULTS: At least one microbial marker was positive in 80% of NRCD patients, in 97% of untreated CD and 87% of treated CD patients, and in 44% of controls. NRCD patients had the highest frequency of ASCA positivity (65% vs 52, 20, and 0%, respectively) and also significantly higher ASCA IgA (median 14.5 U/ml) and IgG (32.5 U/ml) titers than treated CD patients (7.0 U/ml, 13.0 U/ml) and non-CD controls (4.5 U/ml, 5.8 U/ml). The frequencies of I2 and OmpW were lower in NRCD than in untreated CD (65% and 45% vs 86% and 59%, respectively), and I2 titers were higher in NRCD (median absorbance 0.76) and untreated (1.0) and treated (0.83) CD than controls (0.32). OmpW was elevated in untreated (1.1) and treated (0.94) CD patients compared with controls (0.79). CONCLUSIONS: Seropositivity and high titers of ASCA are associated with NRCD and might serve as an additional follow-up tool in CD.
BACKGROUND AND AIMS: In nonresponsive celiac disease (NRCD), the symptoms and duodenal damage persist despite a gluten-free diet. Celiac diseasepatients with persistent symptoms are found to have a dysbiotic microbiota. We thus hypothesized that increased seroreactivity to the serum gluten-sensitive microbial antibodies Saccharomyces cerevisiae (ASCA), Pseudomonas fluorescens-associated sequence (I2), and Bacteroides caccae TonB-linked outer membrane protein (OmpW) is associated with NRCD. METHODS: ASCA, I2 and OmpW were measured in 20 seronegative CDpatients with persistent villous damage despite strict dietary treatment (NRCD group). Fifty-eight responsive patients served as CD controls (55 on gluten-free treatment) and 80 blood donors as non-CD controls. RESULTS: At least one microbial marker was positive in 80% of NRCD patients, in 97% of untreated CD and 87% of treated CDpatients, and in 44% of controls. NRCD patients had the highest frequency of ASCA positivity (65% vs 52, 20, and 0%, respectively) and also significantly higher ASCA IgA (median 14.5 U/ml) and IgG (32.5 U/ml) titers than treated CDpatients (7.0 U/ml, 13.0 U/ml) and non-CD controls (4.5 U/ml, 5.8 U/ml). The frequencies of I2 and OmpW were lower in NRCD than in untreated CD (65% and 45% vs 86% and 59%, respectively), and I2 titers were higher in NRCD (median absorbance 0.76) and untreated (1.0) and treated (0.83) CD than controls (0.32). OmpW was elevated in untreated (1.1) and treated (0.94) CDpatients compared with controls (0.79). CONCLUSIONS: Seropositivity and high titers of ASCA are associated with NRCD and might serve as an additional follow-up tool in CD.
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