Author: Zaid Nabeel Elia
Medical laboratory Department, Erbil Polytechnic University, Technical Health College
Author: Saeed Ghulam Hussain
Microbiology Department, Hawler Medical University
Celiac disease (CD) is an immune mediated malabsorption syndrome that occur in genetically susceptible individuals intolerant to dietary gluten. Although considered as a primary gastrointestinal disease, CD is now known to have widespread systemic manifestation.We attempted to define the nature and role of some systemic cytokine that possibly play a role in the pathophysiology of the disease.
The sera were collected from those patient suspected of having CD on clinical ground (Newly diagnosed) & then subjected to serologic tests namely anti – tissue transglutaminase IgA, IgG (tTG) & IgA, IgG – Endomysial antibody (EMA).
The positive sera for anti – tTG IgA and IgA EMA autoantibody above the cut-off level were then subjected to cytokines assessment namely serum interferon gamma (IFN- γ) and interleukin-10 (IL -10) level.
The participant groups comprised 50 newly diagnosed (ND) CD, 20 patients on gluten free diet (GFD) and 20 apparently healthy CD free control (These groups were subjected to the above parameters).
The results of the present study among the newly diagnosed cases reveals anti-tTG IgA and IgA – EMA seropositivity in 15.1 % of the total 330 sera examined ;with anti-tTG IgG & IgG -EMA seronegativity (below the cut-off ) in all sera tested. The highest percent distribution of anti-tTG IgA and IgA -EMA seropositivity was at the serum concentration of 20-29 (36 % & 34 % respectively).
A significant decrease (P˂ 0.01) was observed in the mean concentration of anti-tTG IgA and IgA- EMA between newly diagnosed CD and patients on GFD. The mean concentration of IFN-γ and IL -10 cytokine was significantly higher (P ˂ 0.01) among newly diagnosed and patient on GFD when compared with health control.
The serum concentration of IFN-γ and IL-10 according to mode of clinical presentation & duration of disease revealed no significant differences (P > 0.05) except for IL – 10 (≤ 3 years & > 3 years on GFD) P ˂ 0.05. In newly diagnosed CD patient, a correlation exist between anti – tTG IgA & IL -10 (P <0.02 ), as IL – 10 has immunostimulatory effect on B – cells.
Keywords: Celiac disease ; IFN-γ ; IL-10; tTG ; EMA.
- Lindfors, K. ; Maki, M. & Kaukinen, K. (2010). Transglutaminase-2- targeted autoantibodies in celiac disease: Pathogenetic players in addition to diagnostic tools? Autoimmunity review 9.744 – 749 .
- Jabri, B. & Sollid, LM. (2009).Tissue – mediated control of immunopathology in celiac disease.Nat Rev immunol 9:858-70.
- Shan, L.; Molberg, O.; Parrot, I.; Hausch, F.; Filiz, F.; Gray, GM; et al., (2002). Structural basis for gluten intolerance in celiac sprue, science. 297:2257-9.
- Rostom, A. ; Dube, C. ; Cranney, A. ; Saloojee, N. ; Garritty, C. et al., (2005). The diagnostic accuracy of serologic tests for celiac disease: a systemic review. Gastroenterology. 128:538 – 46.
- Fernandz-Banares, F. ; Alsina, M. ; Modolell, I. ; Xavier, A. ; Marta, P. et al., (2012). Are positive serum-IgA tissue transglutaminase antibodies enough to diagnose celiac disease without a small bowel biopsy? Post-test probability of celiac disease. Jornal of chrohn’s and Colitis. P:6.
- Catassi, C. & Fasano, A. (2010). Celiac disease diagnosis: simple rules are better than complicated algorithms. Am J Med. 123:691 – 3.
- Wapenaar, MC. ; van Belzen, MJ. ; Fransen, JH. ; Sarasqueta, A. ; Houwen, RHJ. et al., (2004). The interferon gamma gene in celiac disease: augmented expression correlates with tissue damage but not evidence for genetic susceptibility. J Autoimmunity 23:183 – 190.
- Ferretti, G. ; Bacchetti, T. ; Masciangelo, S. & Saturni, L. (2012). Celiac disease, Inflammation and oxidative damage : A nutrigenetic approach. Nutrients 4,243 – 257.
- Juuti-Uusitalo, K. ; Maki, M. ; Kaukinen, K. ; Collin, P. ; Visakorpi, T. et al., (2004). cDNA microarray analysis of gene expression in celiac disease jejunal biopsy samples. J. Autoimmune. 22,249 – 265.
- Cataldo, F. ; Lio, D. ; Marino, V. ; Scola, L. ; Crivello, A. & Corazza, G.R. (2003). Plasma cytokine profiles in patients with celiac disease and selective IgA deficiency. Pediatr Allergy Immunol. 14(4):320 – 324.
- Manavalan, J. ; Hernandez, L. ; Shah, J. ; Konikkara, J. Lee, A. et al., (2010). Serum cytokine elevations in celiac disease: Association with disease presentation. Human Immunology 71:50 – 57.
- Forsberg, G. ; Hernell, O. ; Melgra, S. ; Israelsson, A. ; Hammarstrom, S. & Hammarstrom, ML. (2002). Paradoxical coexpression of proinflammatory and down regulatory cytokines in intestinal T-cells in childhood celiac disease. Gastroenterology 123:667 – 78.
- Forsberg, G. ; Hernell, O. ; Hammarstrom, S. & Hammarstrom, M. (2007). Concomitant increase of IL-10 and proinflammatory cytokines in intraepithelial lymphocyte subsets in celiac disease. international immunology, Vol.19, No. 8, pp. 993 – 1001.
- Schultz, Cl. & Coffman, RL. (1991). Control of isotype switching by T-cells and cytokines. Curr Opin Immunol. 3:350 – 4.
- Picarelli, A. ; di Tola, M. ; Sabbatella, L. ; Mastracchio, A. ; Trecca, A. et al., (2001). Identification of a new celiac disease subgroup: anti endomysial and anti tissueglutaminase antibodies of IgG class in the absence of selective IgA defiency. J Intern Med 249:181 – 8.
- Conti, P. ; Kempuraj, D. ; Kandere, K. ; Gioacchino, M. et al., (2003). IL-10, an inflammatory / inhibitory cytokine, but not always. Immunology Letters 86:123 – 129.