Celiac Disease Autoantibodies in Severe Autoimmune Liver Disease and the Effect of Liver Transplantation

Overview

Journal Liver Int

Specialty Gastroenterology

Date 2008 Mar 15

PMID 18339073

Citations 24

Authors

Alberto Rubio-Tapia

Ahmad S Abdulkarim

Russell H Wiesner

S Breanndan Moore

Patricia K Krause

Joseph A Murray

Affiliations

Soon will be listed here.

Abstract

Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics.

Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and > or = 24 months post-transplantation. Results were correlated with the HLA type of the recipient.

Results: Serological evidence of CD was found in 3% (ESALD) vs. 0.6% (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4%, P=0.0001) and EMAs (4.3 vs. 0.78%, P=0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100%, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD.

Conclusions: Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.

Citing Articles

The Association of Human Leukocyte Antigen Genotyping Among Sudanese Patients With Rheumatoid Arthritis: Reference to Ethnicity.

Ali A, Khalid K, Hussien H, Mohammed S, Saeed O Cureus. 2023; 15(8):e43905.

PMID: 37746389 PMC: 10512431. DOI: 10.7759/cureus.43905.

Association of Human Leukocyte Antigen (HLA) class II ( and ) alleles and haplotypes with Rheumatoid Arthritis in Sudanese patients.

Ali A, Khalid K, Mohammed S, Akhtar M, Saeed O Front Immunol. 2023; 14:1178546.

PMID: 37426636 PMC: 10324672. DOI: 10.3389/fimmu.2023.1178546.

Restoration of Gluten Tolerance Following Heart Transplantation in a Child With Celiac Disease.

Runde J, Al-Sabti R, Discepolo V, Guandalini S, Azzam R JPGN Rep. 2023; 1(2):e004.

PMID: 37206600 PMC: 10191462. DOI: 10.1097/PG9.0000000000000004.

Prevalence of Celiac Disease in Patients with Primary Biliary Cholangitis.

Callichurn K, Cvetkovic L, Therrien A, Vincent C, Hetu P, Bouin M J Can Assoc Gastroenterol. 2021; 4(1):44-47.

PMID: 33644676 PMC: 7898370. DOI: 10.1093/jcag/gwz039.

Discordance Between Serology and Histology for Celiac Disease in a Cohort with Coexisting Liver Disorders.

Cvetkovic L, Bernard G, Galette N, Hetu P, Vincent C, Bouin M J Can Assoc Gastroenterol. 2020; 3(4):185-193.

PMID: 32671328 PMC: 7338843. DOI: 10.1093/jcag/gwz010.

References

PRINCE H, Norman G, Binder W . Immunoglobulin A (IgA) deficiency and alternative celiac disease-associated antibodies in sera submitted to a reference laboratory for endomysial IgA testing. Clin Diagn Lab Immunol. 2000; 7(2):192-6. PMC: 95847. DOI: 10.1128/CDLI.7.2.192-196.2000. View

Bardella M, Vecchi M, Conte D, Del Ninno E, Fraquelli M, Pacchetti S . Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology. 1999; 29(3):654-7. DOI: 10.1002/hep.510290318. View

Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi F . Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet. 1998; 352(9121):26-9. DOI: 10.1016/s0140-6736(97)11222-3. View

Goerres M, Meijer J, Wahab P, Kerckhaert J, Groenen P, van Krieken J . Azathioprine and prednisone combination therapy in refractory coeliac disease. Aliment Pharmacol Ther. 2003; 18(5):487-94. DOI: 10.1046/j.1365-2036.2003.01687.x. View

Lewis N, Scott B . Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests). Aliment Pharmacol Ther. 2006; 24(1):47-54. DOI: 10.1111/j.1365-2036.2006.02967.x. View

Kaukinen K, Halme L, Collin P, Farkkila M, Maki M, Vehmanen P . Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure. Gastroenterology. 2002; 122(4):881-8. DOI: 10.1053/gast.2002.32416. View

Lawson A, West J, Aithal G, Logan R . Autoimmune cholestatic liver disease in people with coeliac disease: a population-based study of their association. Aliment Pharmacol Ther. 2005; 21(4):401-5. DOI: 10.1111/j.1365-2036.2005.02328.x. View

Doolan A, Donaghue K, Fairchild J, Wong M, Williams A . Use of HLA typing in diagnosing celiac disease in patients with type 1 diabetes. Diabetes Care. 2005; 28(4):806-9. DOI: 10.2337/diacare.28.4.806. View

Sollid L, Thorsby E . HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology. 1993; 105(3):910-22. DOI: 10.1016/0016-5085(93)90912-v. View

10.

Halfdanarson T, Litzow M, Murray J . Hematologic manifestations of celiac disease. Blood. 2006; 109(2):412-21. PMC: 1785098. DOI: 10.1182/blood-2006-07-031104. View

11.

Dickey W, McMillan S, Callender M . High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol. 1997; 25(1):328-9. DOI: 10.1097/00004836-199707000-00006. View

12.

Tollefsen S, Arentz-Hansen H, Fleckenstein B, Molberg O, Raki M, Kwok W . HLA-DQ2 and -DQ8 signatures of gluten T cell epitopes in celiac disease. J Clin Invest. 2006; 116(8):2226-36. PMC: 1518792. DOI: 10.1172/JCI27620. View

13.

Rostom A, Dube C, Cranney A, Saloojee N, Sy R, Garritty C . The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology. 2005; 128(4 Suppl 1):S38-46. DOI: 10.1053/j.gastro.2005.02.028. View

14.

Farrell R, Kelly C . Celiac sprue. N Engl J Med. 2002; 346(3):180-8. DOI: 10.1056/NEJMra010852. View

15.

Kingham J, Parker D . The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut. 1998; 42(1):120-2. PMC: 1726939. DOI: 10.1136/gut.42.1.120. View

16.

Kaukinen K, Partanen J, Maki M, Collin P . HLA-DQ typing in the diagnosis of celiac disease. Am J Gastroenterol. 2002; 97(3):695-9. DOI: 10.1111/j.1572-0241.2002.05471.x. View

17.

Murdock A, Johnston S . Diagnostic criteria for coeliac disease: time for change?. Eur J Gastroenterol Hepatol. 2005; 17(1):41-3. DOI: 10.1097/00042737-200501000-00009. View

18.

Duggan J, Duggan A . Systematic review: the liver in coeliac disease. Aliment Pharmacol Ther. 2005; 21(5):515-8. DOI: 10.1111/j.1365-2036.2005.02361.x. View

19.

Vecchi M, Folli C, Donato M, Formenti S, Arosio E, de Franchis R . High rate of positive anti-tissue transglutaminase antibodies in chronic liver disease. Role of liver decompensation and of the antigen source. Scand J Gastroenterol. 2003; 38(1):50-4. View

20.

Fasano A, Berti I, Gerarduzzi T, Not T, Colletti R, Drago S . Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003; 163(3):286-92. DOI: 10.1001/archinte.163.3.286. View