Enterocyte Actin Autoantibody Detection: A New Diagnostic Tool in Celiac Disease Diagnosis: Results of a Multicenter Study

• Published in: The American journal of gastroenterology Vol. 99; no. 8; pp. 1551 - 1556
• Main Authors: Clemente, M.G., Musu, M.P., Troncone, R., Volta, U., Congia, M., Ciacci, C., Neri, E., Not, T., Maggiore, G., Strisciuglio, P., Corazza, G.R., Gasbarrini, G., Cicotto, L., Sole, G., Fasano, A., De Virgiliis, S.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.08.2004; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Actins - immunology; Actins - metabolism; Adolescent; Adult; Aged; Autoantibodies - blood; Biological and medical sciences; Biomarkers - blood; Biopsy; Celiac disease; Celiac Disease - diagnosis; Celiac Disease - pathology; Cells, Cultured; Child; Child, Preschool; Double-Blind Method; Enterocytes - metabolism; Fluorescent Antibody Technique, Indirect; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Immunoglobulin A - blood; Infant; Intestinal Mucosa - metabolism; Intestinal Mucosa - pathology; Medical sciences; Middle Aged; Other diseases. Semiology; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Transglutaminases - immunology; Autoimmunity; Immunopathology; Multicenter study; Autoantibody; Coeliac disease; Result; Intestinal malabsorption; Actin; Gastroenterology; Digestive diseases; Intestinal disease; Enterocyte; Diagnosis; Detection; Tool
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2004.30296.x

This study describes a new method to detect autoantibodies against actin filaments (AAA) as a serological marker of intestinal villous atrophy (IVA) in celiac disease (CD), and reports the results of an Italian double-blind multicenter study. IgA-AAA were analyzed by immunofluorescence using a newly developed method based on intestinal epithelial cells cultured in presence of colchicine. IgA-AAA were blindly evaluated prospectively in 223 antiendomysial antibody (AEA) and/or antitransglutaminase antibody (TGA) positive subjects and in 78 AEA and TGA negative subjects. IgA-AAA positive patients underwent an intestinal biopsy to confirm the diagnosis. Moreover, IgA-AAA were retrospectively investigated in 84 biopsy-proven CD patients and in 2,000 new consecutively collected serum samples from AEA and TGA negative nonbiopsied subjects. IgA-AAA were positive in 98.2% of the CD patients with flat mucosa, in 89% with subtotal villous atrophy, and in 30% with partial villous atrophy. IgA-AAA were present in none of the AEA and TGA negative nonbiopsied controls. In AEA and/or TGA positive CD patients IgA-AAA positivity significantly correlated with IVA (p < 0.000 in the prospective study, p = 0.005 in the retrospective study). In the prospective study, the values of sensitivity, specificity, the positive predictive value, the negative predictive value, and the efficiency of the IgA-AAA test to identify patients with IVA were, respectively, 83.9%, 95.1%, 97.8%, 69.2%, and 87.0%. Furthermore, a significant correlation (p < 0.0001) was found between the IgA-AAA serum titre and the degree of IVA (rs 0.56). The results of this multicenter study show that the new method for IgA-AAA detection could represent a practical diagnostic tool in AEA and/or TGA positive subjects, which would be especially useful when IVA shows a patchy distribution, when the histological picture is difficult to interpret, or when a biopsy could represent a life-threatening risk.