Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis
- L Aparisi1,
- A Farre2,
- L Gomez-Cambronero3,
- J Martinez4,
- G De Las Heras5,
- J Corts6,
- S Navarro7,
- J Mora8,
- M Lopez-Hoyos9,
- L Sabater10,
- A Ferrandez11,
- D Bautista12,
- M Perez-Mateo4,
- S Mery3,
- J Sastre3
- 1Unit of Hepatology, Universitary Clinic Hospital, Valencia, Spain
- 2Service of Gastroenterology, Santa Creu and Sant Pau Hospital, Barcelona, Spain
- 3Department of Physiology, School of Medicine, University of Valencia, Spain
- 4Department of Gastroenterology, University General Hospital, Alicante, Spain
- 5Department of Gastroenterology, Marqués de Valdecilla Hospital, Santander, Spain
- 6Department of Rheumatology, Universitary Clinic Hospital, Valencia, Spain
- 7Department of Gastroenterology, Hospital Clinic and Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- 8Department of Biochemistry, Santa Creu and Sant Pau Hospital, Barcelona, Spain
- 9Department of Immunology, Marqués de Valdecilla Hospital, Santander, Spain
- 10Department of Surgery, Universitary Clinic Hospital, Valencia, Spain
- 11Department of Pathology, School of Medicine, University of Valencia, Spain
- 12Department of Preventive Medicine, Hospital Dr Peset, University of Valencia, Spain
- Correspondence to:
Dr L Aparisi
Servicio de Hepatología, Hospital Clínico Universitario, Avda. Blasco Ibañez 17, 46010 Valencia, Spain;
- Accepted 12 October 2004
- Revised 5 October 2004
Background: Increased serum antibodies against carbonic anhydrase II (CA-II Ab) or IgG4 levels have been reported in cases of autoimmune chronic pancreatitis (ACP).
Aim: To assess the relevance of serum CA-II Ab and IgG4 levels for the diagnosis of ACP in idiopathic CP (ICP) versus alcoholic CP and Sjögren’s syndrome (SS).
Subjects: This was a multicentre study involving 227 subjects divided into four groups: ICP (n = 54), normal controls (n = 54, paired by age and sex with ICP patients), alcoholic CP (n = 86), and SS (n = 33).
Methods: CA-II Ab was measured by ELISA and confirmed by western blotting. A score of easy clinical use with major clinical, morphological, and biochemical parameters for the diagnosis of ACP was applied.
Results: The percentage of patients with increased serum CA-II Ab was higher in the ICP group (28%) than in controls (1.9%) and in patients with alcoholic CP (10.5%), but lower than in patients with SS (64%). The proportion with elevated IgG4 levels was higher in the ICP group (15%) compared with controls (1.9%) and SS (0%) but not significantly different from alcoholic CP (8%). Most ICP patients (7/8) with high IgG4 levels exhibited increased CA-II Ab and a compatible ACP score. A definitive diagnosis of ACP by histological analysis was associated with other autoimmune disorders, an increase in both serum IgG4 and CA-II Ab levels, and IgG4 positive plasma cells.
Conclusions: The increase in serum IgG4 levels was strongly associated with elevated CA-II Ab levels, manifestations compatible with ACP, and lymphoplasmacytic infiltration when surgical specimens were available.
- ACP, autoimmune chronic pancreatitis
- CA- II Ab, antibodies to carbonic anhydrase II
- CP, chronic pancreatitis
- ELISA, enzyme linked immunosorbent assay
- ICP, idiopathic chronic pancreatitis
- SS, Sjögren’s syndrome
- ANA, antinuclear antibodies
- chronic pancreatitis
- autoimmune diseases
- lymphoplamacytic infiltration
Conflict of interest: None declared.