Negative results of antiendomysial antibodies: long term follow up

Fifteen patients with intestinal villous atrophy, but simultaneously negative results of antiendomysial antibodies (EMA) were studied. Two patients were finally diagnosed as having coeliac disease. The predictive value of negative results of EMA assessment in children suspected of coeliac disease is high, approaching 86.7%.

Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis?

Immunoglobulin A (IgA) deficiency is 10 to 15 times more common in patients with celiac disease (CD) than in healthy subjects. Serological tests have become the preferred methods of diagnosing CD in both symptomatic and asymptomatic patients. However, commercially available serological methods are limited in that they detect only the IgA isotype of antibodies (with the exception of IgG gliadin assays); hence, IgA-deficient patients with CD may yield false-negative serology. Fifteen pediatric patients with CD and 10 IgA-deficient pediatric patients without CD were examined for IgA and IgG antibodies to endomysium, gliadin, and tissue transglutaminase. Twenty-five specimens from patients with IgA deficiency were examined. Fifteen were from patients with CD, and 10 were patients without CD. All 15 IgA-deficient patients with CD were positive for endomysium antibodies of the IgG isotype and for IgG gliadin antibodies. All but one of the IgA-deficient patients with CD were also positive for IgG tissue transglutaminase antibodies. None of the IgA-deficient patients without CD were positive for any of the antibody markers. All the specimens examined were also negative for IgA-specific antibodies to endomysium, gliadin, and tissue transglutaminase. IgG-specific antibody tests for endomysium, gliadin, and tissue transglutaminase are useful for the identification of IgA-deficient patients with CD. IgG antibody tests along with tests routinely being used in clinical laboratories can reliably detect all active patients with CD. In addition, the levels of these CD-specific IgG antibodies could be used to monitor patient dietary compliance.

[Selenium plasma concentration level in children with food allergy]

Selenium (Se) is an essential component of many mammalian enzymes and therefore plays an important role in different metabolic processes. Se deficiency occurs in inadequate diet consumption as well as in some digestive tract and allergic diseases. In this research we showed that Se plasma concentration levels in healthy children was 71.8 mg/l, whereas in those with food allergy 54.1 mg/l (with smaller intestinal villus atrophy) or 50.4 mg/l (with greater intestinal villus atrophy). Obtained results indicate that children with food allergy display higher risk of Se deficiency. Antioxidative and immunomodulatory action of Se, connecting with promising literature data of Se supplementation, promote us to state, that this trace element could be used for accessory food allergies treatment.

Tissue transglutaminase and endomysial antibodies-diagnostic markers of gluten-sensitive enteropathy in dermatitis herpetiformis

The association of Durhing's disease, commonly referred to as dermatitis herpetiformis (DH), with gluten-sensitive enteropathy (GSE) is supported by the presence of villous atrophy and endomysial antibodies (EMA). EMA are found to be a marker of GSE both in celiac disease (CD) and in DH. Since tissue transglutaminase (tTG) is believed to be the major autoantigen in GSE, the aim of our study was to determine the specificity and sensitivity of anti-tTG antibody ELISA compared to the EMA indirect immunofluorescence test. We studied 44 cases of DH, confirmed by the presence of IgA immune deposits in the dermal papillae, and 58 cases of CD conforming to the International Criteria of Diagnosing CD. The control group comprised 161 sera from patients with vesiculobullous disorders other than DH and 106 sera from normal healthy blood donors. Anti-tTG antibodies were detected in 36 of 44 DH (79%) and in 32 of 58 CD (55%) patients. EMA were positive in 33 of 44 DH (74%) and in 36 of 58 CD (62%) patients. Both the EMA and the antibodies to tTG were present in the majority of patients with DH and CD when they were on a normal gluten-containing diet and were absent when on a gluten-free diet for an extended period of time. There were, however, small discrepancies in positivity and negativity in tTG antibody-positive and EMA-negative patients and vice versa. There seems to be a correlation between the EMA titers and the anti-tTG antibody levels. This study confirms the high specificity and sensitivity of anti-tTG antibody ELISA for GSE and its strong correlation with EMA both in CD and in DH. The results of anti-tTG antibody and EMA assays were comparable; however, in DH, tTG was somewhat more sensitive than the EMA test. For screening of DH, it is advisable to perform both EMA and anti-tTG antibody tests.

[Immunoglobulin skin and renal deposits in patients with IgA nephropathy and Schonlein-Henoch purpura]

Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.

[The value of IgA endomysium antibodies in diagnosis of coeliac disease among short children]

In recent years a shift in incidence of coeliac disease from the classical to late-onset form has been observed. The main, and often only, symptom of late onset coeliac disease is short stature. The presence of antiendomysial antibodies was found in 14 of 115 children with statural height below the third percentile from randomly chosen kindergartens and schools in Bydgoszcz. Severe atrophy of the intestinal villi in a biopsy specimen confirmed the suspicion of coeliac disease in these children. IgA-EmA are markers of coeliac disease in children with short stature and should be used as a screening test in looking for the causes of short stature.

Aggressive gluten challenge of dermatitis herpetiformis cases converts them from seronegative to seropositive for IgA-class endomysial antibodies

The responses to aggressive gluten challenge of two dermatitis herpetiformis patients with normal gut mucosa and negative serum findings for IgA endomysial antibodies while on normal diets indicate that these patients have a latent gluten-sensitive enteropathy. This was shown further by the control of skin lesions in both cases and in one case by the clearance of the induced gut lesions with a gluten-free diet. Specifically, for 12 to 20 weeks, aggressive gluten challenge (1 to 2 gm/kg/day) of these two patients was followed by both the appearance of and a rise in titer of IgA endomysial antibodies with an exacerbation of skin lesions. After 27 weeks of gluten challenge, histologic studies of the gut showed grade III flattening of the jejunal mucosa in the patient who developed IgA endomysial antibodies 19 weeks before biopsy was performed but not in the patient in whom IgA endomysial antibodies appeared 7 weeks before biopsy was performed. When both patients were placed on a gluten-free diet, IgA endomysial antibodies titers showed negative findings and the skin lesions subsided. It was possible to discontinue dapsone treatment after 30 weeks on a gluten-free diet in one patient and after 33 weeks in the other. It is important to note in the patient who developed grade III (significant) gut pathology after gluten challenge that a third biopsy taken 59 weeks after starting a gluten-free diet revealed a return to a grade II (insignificant) level of villus atrophy. Thus if sulfones are contraindicated in such cases, patients can be treated successfully with a gluten-free diet.

IgA anti-endomysial antibodies in dermatitis herpetiformis: correlation with jejunal morphology, gluten-free diet and anti-gliadin antibodies

Circulating IgA-class anti-endomysium antibodies (EmA) can be detected by indirect immunofluorescence on monkey oesophagus sections. We found EmA in 22 (76%) of 29 patients with dermatitis herpetiformis (DH) on a normal, gluten-containing diet. The highest frequency (100%) of EmA was observed in patients with sub-total villous atrophy. IgA-class antigliadin antibodies (AGA) were found using an ELISA method in 59% of 29 DH patients and in 86% of those with sub-total villous atrophy. There was a significant correlation between EmA titres and AGA levels in individual patients. Gluten-free diet (GFD) treatment caused a rapid decrease in EmA titres; only three of the 12 patients still showed raised EmA after 6-12 months on a GFD and two of these three had failed to adhere to a strict diet. In contrast, no decrease in EmA titres occurred in four patients maintained on a normal diet, and two of the three patients with initially negative EmA developed positive titres when continuing on a normal diet. These results show that both IgA-class EmA and AGA are good indicators of jejunal damage in DH. The rapid fall of EmA titres after gluten withdrawal indicates that this test is also useful for monitoring a patient's adherence to a GFD.

Disease specificity and dynamics of changes in IgA class anti-endomysial antibodies in celiac disease

We evaluated the sensitivity and kinetics of serum IgA class anti-endomysial antibodies in the diagnosis of celiac disease (CD) as established by the criteria of the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN). Eighty-four cases that satisfied the ESPGAN criteria for CD were evaluated for IgA-EmA titers during various phases of establishing the diagnosis. Thirty-three cases were infants and children less than 5 years of age undergoing intestinal biopsies for symptoms of CD and 51 were previously diagnosed adults. Of the 33 children, 11 were untreated and symptomatic and were IgA-EmA positive at initial presentation. Twenty-two children previously controlled on a gluten-free diet (GFD) exhibited IgA-EmA titers during gluten challenge. Furthermore, the antibody levels declined in all cases (usually to negative) when the patients were again placed on a GFD for 6-12 months. Changes in intestinal histopathology paralleled the changes in antibody titers in six cases undergoing serial biopsies. Of the 51 adult patients with proven CD who were prescribed a GFD for at least 12 months, IgA-EmA were detected in 10 cases who were noncompliant to their GFD, whereas the antibodies was found in only 1 of the remaining 41 patients strictly adhering to their diet. The sera of 140 aged-matched children with various intestinal problems, 87 healthy adults, and 67 patients with dermatological diseases served as controls and were also IgA-EmA negative. On the basis of these findings, we suggest a role for the IgA-EmA as a serological screening test for active CD. It further offers the potential for monitoring compliance to diet in established cases of CD and also indicates the proper timing for biopsy in patients undergoing evaluation of CD.

IgA endomysium antibody in children with dermatitis herpetiformis treated with gluten-free diet

The IgA antibody to endomysium of smooth muscle (IgA-EmA) was measured in 32 children with confirmed dermatitis herpetiformis who were eating gluten-free diets. One patient had IgA-EmA before treatment but had a negative test one month later while on the diet. Two so treated for less than one year still had antibody, but of seven children treated for more than one year with gluten-free diet, none had detectable antibody. It was present in 13 of 20 children not adhering to the prescribed diet. The antibody was absent in 4 children with linear IgA bullous dermatosis and 43 children with various skin and intestinal diseases. These findings correspond to those in adults with dermatitis herpetiformis and indicate that IgA-EmA is also a marker for gluten-sensitive enteropathy in children.

IgA anti-endomysial antibody detection in the serum of patients with dermatitis herpetiformis following gluten challenge

This study reports the appearance of IgA-class anti-endomysial antibodies in the serum of 8 out of 12 patients with dermatitis herpetiformis who were challenged with gluten after a number of years of control of the rash with a strict gluten-free diet. Although there was no evidence for the antibodies having any pathogenic role in the rash of dermatitis herpetiformis, their presence may be related to the deterioration in the gluten-sensitive enteropathy.

IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease

The recently described IgA anti-endomysial antibodies (IgA-EmA) are directed against the intermyofibril substance of the smooth muscle, which may correspond either to a reticulin-like structure or a surface component of smooth muscle fibrils. These antibodies occurred in about 80% of sera of thirty-eight patients with dermatitis herpetiformis (DH), in about 70% of twenty-eight patients with coeliac disease and in about 20% of nine patients with other enteropathies. IgG class anti-gliadin antibodies (AGA) also occur in each of these diseases. Both antibodies were detected on monkey oesophagus by immunofluorescence. The IgA-EmA could not be detected in 122 control sera from patients with other gut or skin diseases, including fifteen cases with ulcerative colitis and fifteen cases with linear IgA bullous dermatosis (LABD). The presence and the titre of IgA-EmA and AGA paralleled the severity of the jejunal changes in patients with coeliac disease.

The mutagenic and cell transforming properties of shikimic acid and some of its bacterial and mammalian metabolites

Known and proposed metabolites of shikimic acid were synthesised, characterised and tested for genotoxic activity using the Salmonella/mammalian microsome mutagenicity test, the bacterial fluctuation mutagenicity test and the BHK 21 cell transformation test. Under the conditions used, none of these compounds showed any activity. However, shikimic acid itself was active in the BHK 21 cell transformation assay. It therefore seems unlikely that shikimic acid is a carcinogenic initiating agent, but it may act as a carcinogen-promoting agent in the bracken fern (Pteridium aquilinum).

Immunopathologic and histologic studies on skin from pemphigus patients in tissue culture

Explants of skin from patients with pemphigus vulgaris and pemphigus foliaceus taken in the active stages of the disease had in vivo bound IgG in the intercellular area. After 24-48 h incubation of these explants in normal sera acantholytic bullae developed above the stratum basale, thus indicating that the bound IgG is probably in vivo bound pemphigus antibody. In both cases, skin from the inactive stage of the disease contained no in vivo bound pemphigus antibodies. Explants of these skin specimens failed to develop acantholysis in culture.