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Clinical, HLA, and small bowel immunohistochemical features of children with positive serum antiendomysium antibodies and architecturally normal small intestinal mucosa.
Am J Gastroenterol. 2005 Oct; 100(10):2294-8.AJ

Abstract

BACKGROUND

Antiendomysium antibodies have a high sensitivity and specificity for celiac disease. A small percentage of subjects positive for these antibodies have a small intestinal mucosa hitherto considered normal.

OBJECTIVES

The aim of this study was to characterize the clinical, serological, immunogenetic, and immunohistological features of these subjects.

METHODS

From 409 patients who were positive for celiac-related antibodies, we selected 24 (5.9%) patients who had an architecturally normal small intestinal mucosa. One hundred age-matched celiac patients with a "flat" small intestinal mucosa, and 50 age-matched nonceliac children were also studied. The number of CD3+ and gammadelta+ intraepithelial lymphocytes and of CD25+ lamina propria mononuclear cells, and the expression of crypt HLA-DR and lamina propria ICAM-1 were assessed. HLA haplotyping was also performed.

RESULTS

Eleven (45.8%) of the 24 patients had a distinct infiltrative pattern, i.e., an increase in CD3+ intraepithelial lymphocytes (> 2SD of the nonceliac group), whereas 17 (70.8%) had a higher density of intraepithelial gammadelta+ cells. In 17 (70.8%) patients, the number of lamina propria CD25+ cells was increased and/or the expression of ICAM-1 and crypt HLA-DR was enhanced. All 24 patients carried the celiac disease-associated HLA haplotypes. Two of the six patients who remained on a normal diet and underwent a second jejunal biopsy developed villous atrophy.

CONCLUSIONS

Most of the patients with serum antiendomysium antibodies and normal jejunal histology showed immunohistochemical signs of immune activation in the epithelium, lamina propria, and crypts. We recommend that such patients be monitored to assess their progress and to determine whether they need a gluten-free diet.

Authors+Show Affiliations

Department of Pediatrics and European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16181383

Citation

Paparo, Francesco, et al. "Clinical, HLA, and Small Bowel Immunohistochemical Features of Children With Positive Serum Antiendomysium Antibodies and Architecturally Normal Small Intestinal Mucosa." The American Journal of Gastroenterology, vol. 100, no. 10, 2005, pp. 2294-8.
Paparo F, Petrone E, Tosco A, et al. Clinical, HLA, and small bowel immunohistochemical features of children with positive serum antiendomysium antibodies and architecturally normal small intestinal mucosa. Am J Gastroenterol. 2005;100(10):2294-8.
Paparo, F., Petrone, E., Tosco, A., Maglio, M., Borrelli, M., Salvati, V. M., Miele, E., Greco, L., Auricchio, S., & Troncone, R. (2005). Clinical, HLA, and small bowel immunohistochemical features of children with positive serum antiendomysium antibodies and architecturally normal small intestinal mucosa. The American Journal of Gastroenterology, 100(10), 2294-8.
Paparo F, et al. Clinical, HLA, and Small Bowel Immunohistochemical Features of Children With Positive Serum Antiendomysium Antibodies and Architecturally Normal Small Intestinal Mucosa. Am J Gastroenterol. 2005;100(10):2294-8. PubMed PMID: 16181383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical, HLA, and small bowel immunohistochemical features of children with positive serum antiendomysium antibodies and architecturally normal small intestinal mucosa. AU - Paparo,Francesco, AU - Petrone,Emma, AU - Tosco,Antonella, AU - Maglio,Maria, AU - Borrelli,Melissa, AU - Salvati,Virginia M, AU - Miele,Erasmo, AU - Greco,Luigi, AU - Auricchio,Salvatore, AU - Troncone,Riccardo, PY - 2005/9/27/pubmed PY - 2005/11/11/medline PY - 2005/9/27/entrez SP - 2294 EP - 8 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 100 IS - 10 N2 - BACKGROUND: Antiendomysium antibodies have a high sensitivity and specificity for celiac disease. A small percentage of subjects positive for these antibodies have a small intestinal mucosa hitherto considered normal. OBJECTIVES: The aim of this study was to characterize the clinical, serological, immunogenetic, and immunohistological features of these subjects. METHODS: From 409 patients who were positive for celiac-related antibodies, we selected 24 (5.9%) patients who had an architecturally normal small intestinal mucosa. One hundred age-matched celiac patients with a "flat" small intestinal mucosa, and 50 age-matched nonceliac children were also studied. The number of CD3+ and gammadelta+ intraepithelial lymphocytes and of CD25+ lamina propria mononuclear cells, and the expression of crypt HLA-DR and lamina propria ICAM-1 were assessed. HLA haplotyping was also performed. RESULTS: Eleven (45.8%) of the 24 patients had a distinct infiltrative pattern, i.e., an increase in CD3+ intraepithelial lymphocytes (> 2SD of the nonceliac group), whereas 17 (70.8%) had a higher density of intraepithelial gammadelta+ cells. In 17 (70.8%) patients, the number of lamina propria CD25+ cells was increased and/or the expression of ICAM-1 and crypt HLA-DR was enhanced. All 24 patients carried the celiac disease-associated HLA haplotypes. Two of the six patients who remained on a normal diet and underwent a second jejunal biopsy developed villous atrophy. CONCLUSIONS: Most of the patients with serum antiendomysium antibodies and normal jejunal histology showed immunohistochemical signs of immune activation in the epithelium, lamina propria, and crypts. We recommend that such patients be monitored to assess their progress and to determine whether they need a gluten-free diet. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16181383/Clinical_HLA_and_small_bowel_immunohistochemical_features_of_children_with_positive_serum_antiendomysium_antibodies_and_architecturally_normal_small_intestinal_mucosa_ L2 - https://Insights.ovid.com/pubmed?pmid=16181383 DB - PRIME DP - Unbound Medicine ER -