Chapter 127 : Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease

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The diagnostic usefulness of serological testing for celiac disease (CD) is well established since the antigens and the immune response involved in its pathogenesis are now known. Serological tests for inflammatory bowel diseases (IBDs) (Crohn’s disease and ulcerative colitis [UC]) have been relatively recently developed, and although clinical use is growing, controversy about their role in diagnosis and management continues. CD is now recognized to be one of the most common inherited diseases in humans, and serological testing has become an indispensable tool for detecting it. Individuals with CD make an immune response directed at a combinatorial antigen involving gliadin (the ethanol-soluble protein of gluten) and tissue transglutaminase (tTG), a ubiquitous enzyme which uses gliadin as a source of glutamine residues that it adds to tissue proteins. Antigliadin antibody (AGA) was the first serological test used to detect CD and to monitor patient compliance with a gluten-free diet. Enzyme immunoassay (EIA) is the method most commonly used to measure AGA. Inflammation in Crohn’s disease is segmental, with affected areas alternating with normal areas in the small intestine. Treatment of Crohn’s disease was formerly limited to anti-inflammatory drugs, rest, and good supportive care. Within the past few years, a new approach to therapy has proven very successful in patients with predominantly small intestinal involvement. Monoclonal antibodies to tumor necrosis factor alpha (TNF-α), a cytokine critical in the inflammatory pathways in Crohn’s disease, or TNF-α receptor analogues are able to block TNF-α activity and dramatically reduce inflammation and clinical symptoms.

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127

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Crohn's Disease
Tumor Necrosis Factor alpha
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Image of FIGURE 1

Characteristic staining pattern of IgA AEMA on monkey esophagus section as revealed by IIFM.

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127
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Image of FIGURE 2

Staining pattern of atypical P-ANCA associated with IBD on ethanol-fixed human neutrophils as revealed by IIFM. Contrast with typical P-ANCA in Fig. 2 , chapter 118, this volume ( ).

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127
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1. Aleanzi, M.,, A. M. Demonte,, C. Esper,, S. Garcilazo, and , M. Waggener. 2001. Celiac disease antibody recognition against native and selectively deamidated gliadin peptides. Clin. Chem. 47:20232028.
2. Beutner, E.,, T. P. Chorzelski, and , V. Kumar (ed.). 1987. Immunopathology of the Skin, 3rd ed., sections 24-28. Churchill Livingstone, New York, N.Y.
3. Carroccio, A.,, G. Vitale,, L. Di Prima,, N. Chifari,, S. Napoli,, C. La Russa,, G. Gulotta,, M. R. Averna,, G. Montalto,, S. Mansueto, and , A. Notarbartolo. 2002. Comparison of anti-transglutaminase ELISAs and an anti-endomysial antibody assay in the diagnosis of celiac disease: a prospective study. Clin. Chem. 48:15461550.
4. Cataldo, F.,, V. Marino,, G Botturo,, P. Greco, and , A. Ventura. 1997. Celiac disease and selective IgA deficiency. J. Pediatr. 131:306308.
5. Catassi, C.,, I.-M. Rätsch,, E. Fabiani,, M. Rossini,, G. V. Coppa,, P. L. Giorgi,, E. Bordicchia, and , F. Candela. 2000. Celiac disease in the year 2000: exploring the iceberg. Lancet 343:200203.
6. Chorzelski, T. P.,, J. Sulej,, H. Tchorzewska,, S. Jablonska,, E. H. Beutner, and , V Kumar. 1983. IgA class endomy-sium antibodies in dermatitis herpetiformis and coeliac disease. Ann. N. Y Acad. Sci. 420:325334.
7. Collin, P.,, M. Maki,, O. Keyrilainen,, O. Hallstrom,, T. Reunala, and , A. Pasternack. 1992. Selective IgA deficiency and coeliac disease. Scand. J. Gastroenterol. 27:367371.
8. Dahele, A. V.,, M. C. Aldhous,, K. Humphreys, and , S. Ghosh. 2001. Serum IgA tissue transglutaminase antibodies in celiac disease and other gastrointestinal diseases. Q. J. Med. 94:195205.
9. Dahlbom, I.,, M. Olsson,, N. K. Forooz,, A. G. Sjöholm,, L. Truedsson, and , T. Hansson. 2005. Immunoglobulin G (IgG) anti-tissue transglutaminase antibodies used as markers for IgA-deficient celiac disease patients. Clin. Diagn. Lab. Immunol. 12:254258.
10. Dicke, W. K.,, H. A. Weijers, and , J. H. Van de Kanmer. 1953. The presence in wheat of a factor having a deleterious effect in cases of coeliac disease. Acta Faediatr. Scand. 42:3442.
11. Dickey, W.,, D. F. Hughes, and , S. A. McMillan. 2000. Reliance on serum endomysial antibody testing underestimates the true prevalence of coeliac disease by one-fifth. Scand J. Gastroenterol. 35:181183.
12. Dieterich, W.,, T. Ehnis,, M. Bauer,, P. Donner,, U Volta,, E. O. Riecken, and , D. Schuppan. 1997. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat. Med. 3:797801.
13. Dubé, C.,, A. Rostom,, R. Sy,, A. Cranney,, N. Saloojee,, C. Garritty,, M. Sampson,, L. Zhang,, F. Yazdi,, V Mamaladze,, I. Pan,, J. Macneil,, D. Mack,, D. Patel, and , D. Moher. 2005. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systemic review. Gastroenterology 128:S57S67.
14. Fasano, A. 2005. Clinical presentation of celiac disease in the pediatric population. Gastroenterology 128:S68S73.
15. Fasano, A.,, I. Berti,, T. Gerarduzzi,, T. Not,, R. B. Colletti,, S. Drago,, Y. Elitsur,, P. H. R. Green,, S. Guandalini,, I. D. Hill,, M. Pietzak,, A. Ventura,, M. Thorpe,, D. Kryszak,, F. Fornaroli,, S. S. Wasserman,, J. A. Murray, and , K. Horvath. 2003. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multi-center study. Arch. Intern. Med. 163:286292.
16. Feighery, L.,, C. Collins,, C. Feighery,, N. Malumud,, G. Coughlan,, R. Willoughby, and , J. Jackson. 2003. Anti-transglutaminase antibodies and the serological diagnosis of coeliac disease. Br. J. Biomed. Sci. 60:1418.
17. Green, P. H. R.,, K. Rostami, and , M. N. Marsh. 2005. Diagnosis of celiac disease. Best Pract. Res. Clin. Gastroenterol. 19:389400.
18. Horvath, K., and , I. D. Hill. 2002. Anti-tissue transgluta-minase antibody as the first line screening for celiac disease: good-bye antigliadin tests? Am. J. Gastroenterol. 97:27022704.
19. Koning, F.,, D. Schuppan,, N. Cerf-Bensussan, and , L. M. Sollid. 2005. Pathomechanisms in celiac disease. Best Fract. Res. Clin. Gastroenterol. 19:373387.
20. Korponay-Szabo, I. R.,, I. Dahlbom,, K. Laurila,, S. Koskinen,, N. Woolley,, J. Partenen,, J. B. Kovacs,, M. Maki, and , T. Hansson. 2003. Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency. Gut 52:15671571.
21. Kumar, V.,, M. Jarzabek-Chorzelska,, J. Sulej,, K. Karnewska,, T. Farrell, and , S. Jablonska. 2002. Celiac disease and immunoglobulin A deficiency: how effective are the serological methods of diagnosis? Clin. Diagn. Lab. Immunol. 9:12951300.
22. Mäki, M.,, K. Mustalahti,, J. Kokkonen,, P. Kulmala,, M. Haapalahti,, T. Karttunen,, J. Ilonen,, K. Laurila,, I. Dahlbom,, T. Hansson,, P. Höpfl, and , M. Knip. 2003. Prevalence of celiac disease among children in Finland. N. Engl. J. Med. 348:25172524.
23. Marsh, M. N. (ed.). 1992. Coeliac Disease, p. 192214. Blackwell Scientific, Oxford, United Kingdom.
24. Marsh, M. N. 1992. Gluten, major histocompatibility complex and the small intestine. Gastroenterology 102:330354.
25. Murray, J. A.,, A. J. Herlein,, F. Mitros, and , J. A. Goeken. 2000. Serologic testing for celiac disease in the United States: results of a multilaboratory comparison study. Clin. Diagn. Lab. Immunol. 7:584587.
26. Pedreina, S.,, E. Sugai,, M. Moreno,, H. Vazquez,, S. Niveloni,, E. Smecuol,, R. Mazure,, Z. Kogan,, E. Maurino, and , J. C. Bai. 2005. Significance of smooth muscle/anti-actin autoantibodies in celiac disease. Acta Gastroenterol. Latinoam. 35:8393.
27. Peracchi, M.,, C. Trovato,, M. Longhi,, M. Gasparin,, D. Conte,, C. Tarantino,, D. Prati, and , M. T. Bardella. 2002. Tissue transglutaminase antibodies in patients with end-stage heart failure. Am. J. Gastroenterol. 97:28502854.
28. Stern, M., and the Working Group on Serologic Screening for Celiac Disease. 2000. Comparative evaluation of serologic tests for celiac disease: a European initiative towards standardization. J. Pediatr. Gastroenterol. Nutr. 31:513519.
29. Tursi, A.,, G. Brandimarte, and , G. M. Giorgetti. 2003. Prevalence of antitissue transglutaminase antibodies in different degrees of intestinal damage in celiac disease. J. Clin. Gastroenterol. 36:219221.
30. van Heel, D. A.,, K. Hunt,, L. Greco, and , C. Wijmenga. 2005. Genetics in coeliac disease. Best Fract. Res. Clin. Gastroenterol. 19:323339.
31. Volta, U.,, A. Granito,, L. De Franceschi,, N. Petrolini, and , E. B. Bianchi. 2001. Anti-tissue transglutaminase antibodies as predictors of silent celiac disease in patients with hypertransaminasaemia of unknown origin. Dig. Liver Dis. 33:420425.
32. Weiss, B.,, Y. Bujanover,, B. Avidan,, A. Frandkin,, I. Weintraub, and , B. Shainberg. 2004. Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. Isr. Med. Assoc. J. 6:912.
33. Wong, R. C. W,, R. J. Wilson,, R. H. Steele,, G. Rodford-Smith, and , S. Adelstein. 2002. A comparison of 13 guinea pig and human anti-tissue transglutaminase antibody ELISA kits. J. Clin. Pathol. 55:488494.
34. Andres, P. G., and , L. S. Friedman. 1999. Epidemiology and natural course of inflammatory bowel disease. Gastroenterol. Clin. N. Am. 28:255281.
35. Glas, J.,, H.-P. Török,, E. Vilsmaier,, K.-H. Herbinger,, M. Hoelscher, and , C. Folaczny. 2002. Anti-Saccharomyces cerevisiae antibodies in patients with inflammatory bowel disease and their first-degree relatives: potential clinical value. Digestion 66:173177.
36. Hardarson, S.,, D. R. Labrecque,, F. A. Mitros,, G. A. Neil, and , J. A. Goeken. 1993. Anti-neutrophil cytoplasmic antibody (ANCA) in inflammatory bowel and hepatobiliary diseases: high prevalence in ulcerative colitis, primary scle-rosing cholangitis and autoimmune hepatitis. Am. J. Clin. Pathol. 99:277281.
37. Hoffenberg, E.,, S. Fidanza, and , A. Sauaia. 1999. Serologic testing for inflammatory bowel disease. J. Fediatr. 134:447452.
38. Klebl, F. H.,, F. Bataille,, C. R. Bertea,, H. Herfarh,, E. Hofstädter,, J. Schölmerich, and , G. Rogler. 2003. Association of perinuclear antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies with Vienna classification subtypes of Crohn’s disease. Inflamm. Bowel Dis. 9:302307.
39. Mulder, A. H. L.,, J. Broekroelofs,, G. Horst,, P. C. Limburg,, G. F. Nelis, and , C. G. M. Kallenberg. 1994. Anti-neutrophil cytoplasmic antibodies (ANCA) in inflammatory bowel disease: characterization and clinical correlates. Clin. Exp. Immunol. 95:490497.
40. Nielsen, H.,, A. Wiik, and , J. Elmgreen. 1983. Granulocyte specific antinuclear antibodies in ulcerative colitis. Aid in differential diagnosis of inflammatory bowel disease. Acta Pathol. Microbiol. Scand. Sect. C 91:2326.
41. Papadakis, K. A., and , S. R. Targan. 1999. Serologic testing in inflammatory bowel disease: its value in indeterminate colitis. Curr. Gastroenterol. Rep. 1:482485.
42. Podolsky, D. K. 2002. Inflammatory bowel disease. N. Engl. J. Med. 347:417429.
43. Quinton, J. E.,, B. Sendid,, D. Reumaux,, P. Duthilleul,, A. Cortot,, B. Grandbastien,, G. Charrier,, S. R. Targan,, J. F. Colombel, and , D. Poulain. 1998. Anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 42:788791.
44. Ruemmele, F. M.,, S. R. Targan,, G. Levy,, M. Dubinsky,, J. Braun, and , E. G. Seidman. 1998. Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease. Gastroenterology 115:822829.
45. Savige, J.,, W. Dimech,, M. Fritzler,, J. Goeken,, E. C. Hagen,, D. Jayne,, J. C. Jennette,, R. McEvoy,, W. Pollock,, C. Pusey,, M. Trevisin,, A. Wiik, and , R. Wong. 2003. Addendum to the International Consensus Statement on Testing and Reporting of Antineutrophil Cytoplasmic Antibodies (ANCA)—quality control guidelines, comments and recommendations for testing in other autoimmune diseases. Am. J. Clin. Pathol. 120:312318.
46. Savige, J.,, D. Gillis,, E. Benson,, D. Davies,, V. Esnault,, R. J. Falk,, E. C. Hagen,, D. Jayne,, J. C. Jennette,, B. Paspaliaris,, W. Pollock,, C. Pusey,, C. O. Savage,, R. Silvestrini,, F. van der Woude,, J. Wieslander, and , A. Wiik. 1999. International Consensus Statement on Testing and Reporting of Antineutrophil Cytoplasmic Antibodies (ANCA). Am. J. Clin. Pathol. 111:507513.
47. Seibold, F.,, P. Weber,, R. Klein,, P. A. Berg, and , K. H. Weidman. 1992. Clinical significance of antibodies against neutrophils in patients with inflammatory bowel disease and primary sclerosing cholangitis. Gut 37:657662.
48. Stotland, B. R.,, R. R. Stein, and , G. Lichtenstein. 2000. Advances in inflammatory bowel disease. Med. Clin. N. Am. 84:11071124.
49. Vasiliauskas, E. A.,, L. Y. Kam,, L. C. Karp,, J. Gaiennie,, H. Yang, and , S. R. Targan. 2000. Marker antibody expression stratifies Crohn’s disease into immunologically homogenous subgroups with distinct clinical characteristics. Gut 47:487496.
50. Wiik, A. 2002. Antineutrophil cytoplasmic antibodies (ANCAs) and ANCA testing, p. 981986. In N. R. Rose,, R. G. Hamilton, and , B. Detrick (ed.), Manual of Clinical Laboratory Immunology, 6th ed. ASM Press, Washington, D.C.


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Sensitivity and specificity of serological tests for CD

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127

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