Binding to human jejunum of serum IgA antibody from children with coeliac disease
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S Kárpáti1, A Bürgin-Wolff, T Krieg
1Department of Dermatology, Heim Pál Hospital for Children, Budapest, Hungary.
Insights
Serum IgA antibodies binding to the jejunum (JAB) are present in most children with celiac disease on a gluten-containing diet. JAB levels decrease on a gluten-free diet and may be identical to antiendomysium antibodies.
Area of Science:
- Gastroenterology and Immunology
- Pediatric Celiac Disease Research
Background:
- Severe malabsorptive symptoms in children warrant investigation into underlying causes.
- Celiac disease diagnosis relies on jejunal histology and serological markers.
- The role of specific autoantibodies in celiac disease pathogenesis requires further elucidation.
Purpose of the Study:
- To investigate jejunal histology and serum IgA antibodies (JAB) binding to the human jejunum in children with malabsorption.
- To assess the diagnostic utility of JAB in confirmed and probable celiac disease.
- To compare JAB with other known celiac disease antibodies, antigliadin (AGA) and antiendomysium (EMA).
Main Methods:
- Studied 139 children with severe malabsorptive symptoms, including those with confirmed celiac disease, probable celiac disease, and disease controls.
- Assessed jejunal histology and measured serum IgA antibodies (JAB) binding to human jejunum in vitro.
- Compared JAB levels in children on gluten-free diets, gluten challenge, and those with normal histology or selective IgA deficiency.
- Performed simultaneous determination of antigliadin (AGA) and antiendomysium (EMA) levels.
Main Results:
- 93% of children with confirmed celiac disease had JAB before a gluten-free diet; none had JAB on a long-term gluten-free diet.
- 90% of children with confirmed celiac disease had JAB during gluten challenge, and 71-94% of children with probable celiac disease had JAB during gluten intake.
- JAB were not detected in disease controls or in coeliac disease patients with selective IgA deficiency.
- JAB differed from AGA but were likely identical to EMA.
Conclusions:
- Serum IgA antibodies binding to the jejunum (JAB) are a sensitive marker for celiac disease in children, particularly when consuming gluten.
- JAB levels decrease significantly upon adherence to a gluten-free diet.
- IgA JAB may represent target-organ-specific autoantibodies involved in the autoimmune response in celiac disease.
Abstract:
Jejunal histology and the presence of serum IgA antibodies (JAB) binding to human jejunum in vitro were studied in 139 children with severe malabsorptive symptoms. Among 33 children with confirmed coeliac disease (ESPGAN criteria), 13 (93%) of 14 sampled before starting on a gluten-free diet had JAB, none of 21 sampled had JAB while on a gluten-free diet of long duration, and 90% of 30 sampled during gluten challenge had JAB. 53 children had severe jejunal villous atrophy (probable coeliac disease): 71% of those younger than 2 years and 94% of those aged 2-18 years had JAB during gluten intake. JAB could not be detected in 53 disease control patients (normal jejunal histology) and in 3 coeliac disease patients with selective IgA deficiency. Simultaneous determination of antigliadin (AGA) and antiendomysium (EMA) levels, and gliadin and tissue absorption studies, showed that JAB and AGA are different, whereas JAB and EMA are probably identical. IgA JAB could be the target-organ-related autoantibodies in coeliac disease.