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Gut 47:520-526 doi:10.1136/gut.47.4.520
  • Small intestinal disease

Immune reaction against the cytoskeleton in coeliac disease

Abstract

BACKGROUND The cytoskeleton actin network of intestinal microvilli has been found to be rapidly impaired after gluten challenge in coeliac disease (CD). The aim of this study was to investigate the presence of an immune reaction towards cytoskeleton structures such as actin filaments in CD.

METHODS Eighty three antiendomysial antibody positive CD patients (52 children and 31 adults) were studied at our outpatient clinics from 1996 to 1998 using indirect immunofluorescence, ELISA, and western blotting for antiactin (AAA) and antitissue transglutaminase (TGA) antibodies before and after a gluten free diet (GFD). Sixteen patients with smooth muscle antibody positive autoimmune hepatitis, 21 with inflammatory bowel diseases, seven with small bowel bacterial overgrowth, and 60 healthy subjects were studied as controls.

RESULTS Fifty nine of 83 CD patients (28/31 adults (90.3%); 31/52 children (59.6%)) were positive for IgA and/or IgG AAA. Seventy seven (92.7%) were positive for IgA TGA. IgA AAA were strongly correlated with more severe degrees of intestinal villous atrophy (p<0.0001; relative risk 86.17). After a GFD, AAA became undetectable within five months.

CONCLUSIONS Apart from the immune reaction against the extracellular matrix, we have described an immune reaction against the cytoskeleton in both children and adults with CD. As AAA are strongly associated with more severe degrees of villous atrophy, they may represent a useful serological marker of severe intestinal atrophy in CD.

Footnotes

  • Abbreviations used in this paper:
    AAA
    antiactin antibodies
    GFD
    gluten free diet
    AEA
    antiendomysium antibodies
    AGA
    antigliadin antibodies
    AH
    autoimmune hepatitis
    IBD
    inflammatory bowel disease
    AMA
    antimitochondrial antibodies
    IF
    indirect immunofluorescence
    ANA
    antinuclear antibodies
    ANCA
    antineutrophil cytoplasm antibodies
    ARA
    antireticulin antibodies
    CD
    coeliac disease
    LC-1
    antiliver cytosol 1 antibodies
    LKM
    antiliver kidney microsome antibodies
    SMA
    smooth muscle antibodies
    PBS
    phosphate buffered saline
    SLA
    antisoluble liver antigen antibodies
    TGA
    antitransglutaminase antibodies
    tTG
    tissue transglutaminase
    RR
    relative risk