Assessing Possible Celiac Disease by an HLA-DQ2-gliadin Tetramer Test

被引:52
作者
Brottveit, Margit [1 ]
Raki, Melinda [2 ]
Bergseng, Elin [2 ]
Fallang, Lars-Egil [2 ]
Simonsen, Bjorg [2 ]
Lovik, Astrid [3 ]
Larsen, Stig [4 ]
Loberg, Else Marit [5 ]
Jahnsen, Frode L. [2 ,6 ]
Sollid, Ludvig M. [2 ]
Lundin, Knut E. A. [2 ]
机构
[1] Oslo Univ Hosp, Dept Gastroenterol, Ulleval, Norway
[2] Univ Oslo, Inst Immunol, Ctr Immune Regulat, N-0316 Oslo, Norway
[3] Natl Hosp Norway, Oslo Univ Hosp, Dept Med, Oslo, Norway
[4] Norwegian Sch Vet Med, Oslo, Norway
[5] Oslo Univ Hosp, Dept Pathol, Ulleval, Norway
[6] Natl Hosp Norway, Oslo Univ Hosp, Dept Pathol, Oslo, Norway
关键词
GLUTEN-FREE DIET; T-CELLS; CLINICAL-RESPONSE; PERIPHERAL-BLOOD; FOOD ALLERGY; CHALLENGE; PREVALENCE; DIAGNOSIS; INTOLERANCE; CHILDREN;
D O I
10.1038/ajg.2011.23
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
OBJECTIVES: Investigation of uncertain celiac disease (CD) in patients already on a gluten-free diet (GFD) is difficult. We evaluated HLA-DQ2-gliadin tetramers for detection of gluten-specific T cells in peripheral blood and histological changes in the duodenum after a short gluten challenge as a diagnostic tool. METHODS: HLA-DQ2 + individuals on a GFD for at least 4 weeks were investigated; 35 with uncertain diagnosis, 13 CD patients, and 2 disease controls. All participants had a challenge with four slices of gluten-containing white bread, daily for 3 days (d1-d3). An esophagogastroduodenoscopy with biopsy sampling was done on d0 and d4. Biopsies were scored according to revised Marsh criteria. Peripheral blood CD4 + T cells were isolated, stained with HLA-DQ2-gliadin peptide tetramers, and analyzed by flow cytometry on d0 and d6. RESULTS: After challenge, a positive tetramer test was seen in 11/13 CD patients. Four of these subjects also showed typical histological changes on challenge. Of the 35 patients with uncertain diagnosis, 3 were diagnosed with CD. Two of these three patients had both positive tetramer staining and histological changes in biopsies after challenge. CONCLUSIONS: Tetramer staining for gluten-specific T cells is a sensitive method in detecting an immune response in CD patients after a short gluten challenge. The prevalence of CD in the group with self-prescribed GFD was about 10%
引用
收藏
页码:1318 / 1324
页数:7
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