Department of Internal Medicine and Medical Specialties, Sapienza University - Polyclinic Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy,
J Clin Immunol. 2013 Oct;33(7):1250-6. doi: 10.1007/s10875-013-9920-3. Epub 2013 Jul 6.
Celiac disease (CD), a systemic autoimmune disorder that typically involves duodenal mucosa, can also affect other intestinal areas. Duodenal and oral mucosa organ culture has already been demonstrated as a reliable procedure to identify CD. The present study investigated gluten-dependent immunological activation of colonic mucosa in CD patients. We took advantage of the numerous colonoscopies performed for various clinical conditions or only for defensive medicine.
Forty-four patients with gastrointestinal symptoms or in need of colorectal cancer screening were divided into patients with serum anti-endomysium (EMA) and anti-tissue transglutaminase (anti-tTG) antibody positive results (Group A), patients with serum antibody negative results (Group B), and patients with inflammatory bowel disease (IBD) (Group C). The autoantibodies EMA and anti-tTG were evaluated in supernatants of cultured sigmoid and duodenal biopsies from patients on a gluten-containing diet.
In Group A, EMA and anti-tTG resulted positive in all duodenal culture supernatants. In sigmoid culture supernatants, EMA and anti-tTG were detected in 12/16 (75 %) and 13/16 (81.3 %) patients, respectively. In Group B, none of the 17 patients showed EMA and anti-tTG positive results in both duodenal and sigmoid cultures. In Group C, all 11 patients presented EMA negative results in sigmoid cultures. Only in one patient, anti-tTG were detectable in the sigmoid culture supernatant, as expected in cases of IBD.
Data confirm that the gluten-dependent immunological activation affects more intestinal tracts with different degrees of involvement, suggesting that the organ culture of colonic biopsies could represent a new tool to opportunistically detect CD.
乳糜泻（CD）是一种系统性自身免疫性疾病，通常涉及十二指肠黏膜，也可影响其他肠道区域。十二指肠和口腔黏膜器官培养已被证明是识别 CD 的可靠方法。本研究调查了 CD 患者结肠黏膜对谷蛋白的免疫依赖性激活。我们利用因各种临床情况或仅为预防医学而进行的大量结肠镜检查。
44 例有胃肠道症状或需要结直肠癌筛查的患者分为血清抗内肌内膜（EMA）和抗组织转谷氨酰胺酶（抗-tTG）抗体阳性结果患者（A 组）、血清抗体阴性结果患者（B 组）和炎症性肠病（IBD）患者（C 组）。将含有谷蛋白的饮食患者的乙状结肠和十二指肠活检的培养上清液中的自身抗体 EMA 和抗-tTG 进行评估。
在 A 组中，所有十二指肠培养上清液的 EMA 和抗-tTG 均为阳性。在乙状结肠培养上清液中，12/16（75%）和 13/16（81.3%）患者分别检测到 EMA 和抗-tTG 阳性。在 B 组中，17 例患者的十二指肠和乙状结肠培养均未出现 EMA 和抗-tTG 阳性。在 C 组中，11 例患者的乙状结肠培养均未出现 EMA 阴性。仅在 1 例患者的乙状结肠培养上清液中检测到抗-tTG，这与 IBD 的情况相符。
数据证实，谷蛋白依赖性免疫激活影响了不同程度受累的更多肠道，这表明结肠活检的器官培养可能成为一种机会性检测 CD 的新工具。
