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Screening for coeliac disease in families of adults with Type 1 diabetes based on serological markers.

Abstract

The prevalence of coeliac disease (CD) in the adult population is unknown because silent and latent stages do exist. Type 1 diabetes mellitus may be associated with CD because of common genetic background and/or shared pathogenetic mechanisms. We investigated 74 adults with type 1 diabetes (32+/-11 yr, disease duration 13+/-9 yr), 69 parents of diabetic probands (56+/-10 yr), 59 siblings (30+/-11 yr) and 50 healthy controls (35+/-10 yr) for the presence of circulating islet cell antibodies (ICA), anti-glutamic acid decarboxylase antibodies (GADA65), anti-gliadin immunoglobulins A and G (IgA- and IgG-AGA). All patients with raised AGA, performed also IgA anti-endomysium antibody (EmA) indirect immunofluorescence assay. Samples were positive for ICA in 19 diabetics (26%), 4 parents (6%), 4 siblings (7%), 0 controls (p<0.001); for GADA in 34 diabetics (46%), 4 parents (6%), 1 sibling (2%), 0 controls (p<0.001). Twenty-five diabetic patients (34%), 10 parents (14%), 5 siblings (8%), 3 controls (6%) (p<0.001) had raised IgA-AGA (>4.4 mg/l). Four diabetic patients (5%), 5 parents (7%), 0 siblings (0%), 4 controls (8%) had raised IgG-AGA (>18 mg/l). Both IgA- and IgG-AGA were detected in 1 diabetic and 2 parents. The prevalence of ICA, GADA, and IgA-AGA positivity in Type 1 diabetes patients was significantly higher than in controls (p<0.001). Finally, 50 AGA-positive subjects performed EmA test: only 2 of them resulted EmA-positive, a diabetic patient and a sibling. The patient with Type 1 diabetes had a small-bowel biopsy specimen consistent with CD and, as sole evidence of malabsorption, sideropenic anaemia. EmA-positive sibling also showed severe iron deficiency, yet refused endoscopy. We conclude that: 1) CD cannot be diagnosed on the basis of associated IgA- and IgG-AGA alone. Nevertheless, detection of such antibodies is useful, in combination with EmA, in screening for endoscopic biopsy; 2) too high rate of detection of IgA-AGA in Type 1 diabetic patients in comparison with other groups excludes a false positivity of the test itself, while suggests a pathogenetic association of both immunological disorders, perhaps related to abnormal gammadelta TCR-bearing intraepithelial lymphocytes.

Authors+Show Affiliations

,

Dipartimento di Medicina Interna, University of Pisa, Italy.

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Source

Diabetes, nutrition & metabolism 14:1 2001 Feb pg 37-42

MeSH

Adult
Autoantibodies
Biomarkers
Celiac Disease
Diabetes Mellitus, Type 1
Female
Fluorescent Antibody Technique, Indirect
Gliadin
Glutamate Decarboxylase
Humans
Immunoglobulin A
Immunoglobulin G
Intestinal Mucosa
Male
Mass Screening
Middle Aged
Predictive Value of Tests
Prevalence
Sensitivity and Specificity

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11345164

Citation

Matteucci, E, et al. "Screening for Coeliac Disease in Families of Adults With Type 1 Diabetes Based On Serological Markers." Diabetes, Nutrition & Metabolism, vol. 14, no. 1, 2001, pp. 37-42.
Matteucci E, Cinapri V, Quilici S, et al. Screening for coeliac disease in families of adults with Type 1 diabetes based on serological markers. Diabetes Nutr Metab. 2001;14(1):37-42.
Matteucci, E., Cinapri, V., Quilici, S., Lucchetti, A., Mugnaini, P., & Giampietro, O. (2001). Screening for coeliac disease in families of adults with Type 1 diabetes based on serological markers. Diabetes, Nutrition & Metabolism, 14(1), pp. 37-42.
Matteucci E, et al. Screening for Coeliac Disease in Families of Adults With Type 1 Diabetes Based On Serological Markers. Diabetes Nutr Metab. 2001;14(1):37-42. PubMed PMID: 11345164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for coeliac disease in families of adults with Type 1 diabetes based on serological markers. AU - Matteucci,E, AU - Cinapri,V, AU - Quilici,S, AU - Lucchetti,A, AU - Mugnaini,P, AU - Giampietro,O, PY - 2001/5/10/pubmed PY - 2001/9/21/medline PY - 2001/5/10/entrez SP - 37 EP - 42 JF - Diabetes, nutrition & metabolism JO - Diabetes Nutr. Metab. VL - 14 IS - 1 N2 - The prevalence of coeliac disease (CD) in the adult population is unknown because silent and latent stages do exist. Type 1 diabetes mellitus may be associated with CD because of common genetic background and/or shared pathogenetic mechanisms. We investigated 74 adults with type 1 diabetes (32+/-11 yr, disease duration 13+/-9 yr), 69 parents of diabetic probands (56+/-10 yr), 59 siblings (30+/-11 yr) and 50 healthy controls (35+/-10 yr) for the presence of circulating islet cell antibodies (ICA), anti-glutamic acid decarboxylase antibodies (GADA65), anti-gliadin immunoglobulins A and G (IgA- and IgG-AGA). All patients with raised AGA, performed also IgA anti-endomysium antibody (EmA) indirect immunofluorescence assay. Samples were positive for ICA in 19 diabetics (26%), 4 parents (6%), 4 siblings (7%), 0 controls (p<0.001); for GADA in 34 diabetics (46%), 4 parents (6%), 1 sibling (2%), 0 controls (p<0.001). Twenty-five diabetic patients (34%), 10 parents (14%), 5 siblings (8%), 3 controls (6%) (p<0.001) had raised IgA-AGA (>4.4 mg/l). Four diabetic patients (5%), 5 parents (7%), 0 siblings (0%), 4 controls (8%) had raised IgG-AGA (>18 mg/l). Both IgA- and IgG-AGA were detected in 1 diabetic and 2 parents. The prevalence of ICA, GADA, and IgA-AGA positivity in Type 1 diabetes patients was significantly higher than in controls (p<0.001). Finally, 50 AGA-positive subjects performed EmA test: only 2 of them resulted EmA-positive, a diabetic patient and a sibling. The patient with Type 1 diabetes had a small-bowel biopsy specimen consistent with CD and, as sole evidence of malabsorption, sideropenic anaemia. EmA-positive sibling also showed severe iron deficiency, yet refused endoscopy. We conclude that: 1) CD cannot be diagnosed on the basis of associated IgA- and IgG-AGA alone. Nevertheless, detection of such antibodies is useful, in combination with EmA, in screening for endoscopic biopsy; 2) too high rate of detection of IgA-AGA in Type 1 diabetic patients in comparison with other groups excludes a false positivity of the test itself, while suggests a pathogenetic association of both immunological disorders, perhaps related to abnormal gammadelta TCR-bearing intraepithelial lymphocytes. SN - 0394-3402 UR - https://www.unboundmedicine.com/medline/citation/11345164/Screening_for_coeliac_disease_in_families_of_adults_with_Type_1_diabetes_based_on_serological_markers_ L2 - http://www.diseaseinfosearch.org/result/2236 DB - PRIME DP - Unbound Medicine ER -