Degree of Damage to the Small Bowel and Serum Antibody Titers Correlate With Clinical Presentation of Patients With Celiac Disease

AbstractThe aim of this study was (1) to prospectively evaluate the nationwide implementation of the ESPGHAN-guidelines for the diagnosis of celiac disease (CD), (2) to investigate the incidence and clinical presentation of diagnosed childhood CD (0–14 years) in the Netherlands, and (3) to compare the findings with national survey data from 1975 to 1990 and 1993 to 2000 using the same approach. From 2010 to 2013, all practicing paediatricians were invited to report new celiac diagnoses to the Dutch Pediatric Surveillance Unit. Data were collected via questionnaires. A total of 1107 children with newly diagnosed CD were reported (mean age, 5.8 years; range, 10 months–14.9 years; 60.5% female). After the introduction of the non-biopsy approach in 2012, 75% of the diagnoses were made according to the guideline with a significant decrease of 46.3% in biopsies. The use of EMA and HLA-typing significantly increased with 25.8% and 62.1%, respectively. The overall incidence rate of childhood CD was 8.8-fold higher than in 1975–1990 and 2.0-fold higher than in 1993–2000. During the study period, the prevalence of diagnosed CD was 0.14%, far below 0.7% of CD identified via screening in the general Dutch paediatric population. Clinical presentation has shifted towards less severe and extra-intestinal symptoms.Conclusion: ESPGHAN guidelines for CD diagnosis in children were effectively and rapidly implemented in the Netherlands. Incidence of diagnosed CD among children is still significantly rising with a continuous changing clinical presentation. Despite the increasing incidence of diagnoses, significant underdiagnosis still remains. What is Known:• Since 2000 the incidence of diagnosed childhood CD in the Netherlands has shown a steady rise.• The rise in incidence has been accompanied by a changing clinical presentation at diagnosis. What is New:• The ESPGHAN guidelines 2012 for CD diagnosis were effectively and rapidly implemented in the Netherlands.• The incidence of diagnosed childhood CD in the Netherlands has continued to rise significantly during the reported period.

Download Full-text

Multiple Small Intestine Ulcers with Desquamation of the Fingers

Case Reports in Gastroenterology ◽

10.1159/000479222 ◽

2017 ◽

Vol 11 (2) ◽

pp. 452-461

Author(s):

Azusa Kawasaki ◽

Kunihiro Tsuji ◽

Hisashi Doyama

Keyword(s):

Computed Tomography ◽

Small Intestine ◽

Abdominal Pain ◽

Small Bowel ◽

Yersinia Pseudotuberculosis ◽

Oral Ulcers ◽

Palmar Erythema ◽

Antibody Titers ◽

Endoscopic Characteristics ◽

Multiple Ulcers

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.

Download Full-text

Advax-CpG Adjuvant Provides Antigen Dose-Sparing and Enhanced Immunogenicity for Inactivated Poliomyelitis Virus Vaccines

Pathogens ◽

10.3390/pathogens10050500 ◽

2021 ◽

Vol 10 (5) ◽

pp. 500

Author(s):

Yoshikazu Honda-Okubo ◽

Jeremy Baldwin ◽

Nikolai Petrovsky

Keyword(s):

Neutralizing Antibodies ◽

Serum Antibody ◽

Oral Polio Vaccine ◽

Antigen Dose ◽

Polio Vaccine ◽

Antibody Titers ◽

Dose Sparing ◽

Sparing Effect ◽

Eradicate Polio

Global immunization campaigns have resulted in a major decline in the global incidence of polio cases, with wild-type poliovirus remaining endemic in only two countries. Live oral polio vaccine (OPV) played a role in the reduction in polio case numbers; however, the risk of OPV developing into circulating vaccine-derived poliovirus makes it unsuitable for eradication programs. Trivalent inactivated polio virus (TIPV) vaccines which contain formalin-inactivated antigens produced from virulent types 1, 2 and 3 reference polio strains grown in Vero monkey kidney cells have been advocated as a replacement for OPV; however, TIPVs have weak immunogenicity and multiple boosts are required before peak neutralizing titers are reached. This study examined whether the incorporation of the novel polysaccharide adjuvant, Advax-CpG, could boost the immunogenicity of two TIPV vaccines, (i) a commercially available polio vaccine (IPOL®, Sanofi Pasteur) and (ii) a new TIPV formulation developed by Statens Serum Institut (SSI). Mice were immunized intramuscularly based on recommended vaccine dosage schedules and serum antibody titers were followed for 12 months post-immunization. Advax-CpG significantly enhanced the long-term immunogenicity of both TIPV vaccines and had at least a 10-fold antigen dose-sparing effect. An exception was the poor ability of the SSI TIPV to induce serotype type 1 neutralizing antibodies. Immunization with monovalent IPVs suggested that the low type 1 response to TIPV may be due to antigen competition when the type 1 antigen was co-formulated with the type 2 and 3 antigens. This study provides valuable insights into the complexity of the formulation of multivalent polio vaccines and supports the further development of adjuvanted antigen-sparing TIPV vaccines in the fight to eradicate polio.

Download Full-text

Changes in the Intestinal Microbiota and Systemic Immune Responses by Dietary 1-Kestose Supplementation in Healthy Dogs

International Journal of Probiotics and Prebiotics ◽

10.37290/ijpp2641-7197.16:7-15 ◽

2020 ◽

Vol 16 (1) ◽

pp. 7-15

Author(s):

T. Tochio ◽

Y. Kadota ◽

Y. Asami ◽

R. Azuma ◽

R. Oishi ◽

...

Keyword(s):

Immune Responses ◽

Intestinal Microbiota ◽

Serum Antibody ◽

Flow Cytometric Analysis ◽

Allergic Diseases ◽

Food Material ◽

Quantification Analysis ◽

Antibody Titers ◽

Healthy Dogs ◽

System 1

1-Kestose is a trisaccharide prebiotic that modifies immune responses in humans and rodents with allergic diseases by altering the intestinal microbiota. In the present study, we examined the effects of 1-kestose supplementation on the intestinal microbiota, peripheral lymphocyte subsets, and antibody production in healthy dogs. Fecal IgA levels and serum antibody titers against the rabies vaccine were not significantly affected by 1-kestose supplementation. In a flow cytometric analysis, the percentage of T cells among total lymphocytes decreased, whereas that of B cells increased in supplemented dogs. A metagenomic analysis of the intestinal microbiota showed that the proportion of Bifidobacterium increased, while that of Lactobacillus did not decrease in supplemented dogs. Furthermore, a quantification analysis using real-time polymerase chain reaction showed that the proportion of Bifidobacterium increased in supplemented dogs. These results suggest that 1-kestose supplementation induced modifications in the intestinal microbiota of dogs, which presumably enhanced the immune system. 1-Kestose may be a useful food material as a prebiotic for dogs.

Download Full-text

BACTERIAL AND VIRAL COPROANTIBODIES IN BREAST-FED INFANTS

PEDIATRICS ◽

10.1542/peds.39.2.202 ◽

1967 ◽

Vol 39 (2) ◽

pp. 202-213

Author(s):

Jean F. Kenny ◽

Mary I. Boesman ◽

Richard H. Michaels

Keyword(s):

Serum Antibody ◽

Neutralizing Antibody ◽

High Serum ◽

Maternal Milk ◽

Neutralizing Activity ◽

E Coli ◽

Immune Globulins ◽

Antibody Titers ◽

Human Immune ◽

Breast Fed

Stools of newborn breast-fed infants may contain significant amounts of hemagglutinating antibody to enteropathogenic E. coli and neutralizing antibody to polioviruses. Stool titers averaged only fourfold lower than maternal milk titers for antibacterial and less than twofold lower for antiviral activity. Similar ratios of stool:milk activity were also found for paired specimens obtained during the second and third postpartum months. The stool antibodies were stable at 56°C and exhibited definite specificity. Bacterial hemagglutinins in feces were more sensitive to mercaptoethanol than the poliovirus neutralizing activity. Stools from breast-fed infants contained gamma-1 globulins similar to those in milk, including IgA and small amounts of IgM. Meconium from bottle-fed infants with high serum antibody titers to polioviruses contained traces of homotypic neutralizing antibody. Antiviral and antibacterial activity were not detected in transitional and later stools from artificially fed infants, nor were human immune globulins. Milk bacterial hemagglutinating antibodies were more resistant to acid and to pepsin than those in serum. Furthermore, acid had a less deleterious effect on virus neutralizing activity in milk than it had on that in serum, and it also had less effect on the milk antiviral than on the milk antibacterial antibodies.

Download Full-text

Study of Antibody Levels in Children with Purulent Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894800890s331 ◽

1980 ◽

Vol 89 (3_suppl) ◽

pp. 117-120 ◽

Cited By ~ 2

Author(s):

P. Branefors ◽

T. Dahlberg ◽

O. Nylén

Keyword(s):

Otitis Media ◽

Serum Antibody ◽

Acute Otitis Media ◽

High Serum ◽

Haemophilus Influenzae Type ◽

Enzyme Linked Immunosorbent Assay ◽

Polysaccharide Antigens ◽

Antibody Titers ◽

Iga Antibody ◽

Antibody Levels

A series of episodes of acute otitis media were studied with reference to the bacterial findings in the nasopharynx and the specific antibody response in a group of children nine months to ten years of age, with previous frequent episodes of acute otitis media, Serum IgG, IgM and IgA antibody levels against five polysaccharide antigens, namely Haemophilus influenzae type b and Streptococcus pneumoniae types 3, 6, 19 and 23, were studied by means of an enzyme-linked immunosorbent assay. The selection of polysaccharide antigens was based on isolation frequency. The sera to be tested were tenfold serially diluted. An extinction of 0.2 over the base was taken as the end-point titer and expressed as in-log10. The results showed that most children including those under three years of age showed increasing homologous antibody titers at an infection, or had already initially very high antibody titers, especially of the IgG class. The titers reached levels of 104 to 105. In some cases, however, it could be shown that high serum antibody titers did not give protection against a new infection with the same serological type of bacteria. It was also demonstrated that most children, regardless of age, had IgG and IgM titers against the heterologous antigens. In some cases the levels were quite high (103 to 104). However, the IgA antibody levels were lower and in a considerable number of samples antibodies were not even detectable.

Download Full-text

Relationships between Clinical Presentation, Serology, Histology, and Duodenal Deposits of Tissue Transglutaminase Antibodies in Pediatric Celiac Disease

Digestive Diseases ◽

10.1159/000490377 ◽

2018 ◽

Vol 36 (5) ◽

pp. 369-376 ◽

Cited By ~ 1

Author(s):

Nurit Loberman-Nachum ◽

Michael Schvimer ◽

Camila Avivi ◽

Iris Barshack ◽

Avishay Lahad ◽

...

Keyword(s):

Celiac Disease ◽

Immunohistochemical Staining ◽

Clinical Presentation ◽

Tissue Transglutaminase ◽

Mucosal Damage ◽

High Serum ◽

Tissue Transglutaminase Antibodies ◽

Antibody Levels ◽

Age Range ◽

Multiple Symptoms

Background: The clinical, histological, and serological spectrum of celiac disease (CD) vary widely. We aimed to examine relationships between symptoms, serum anti-tissue transglutaminase antibodies (tTG) levels, mucosal damage, and mucosal anti-tTG deposits in pediatric CD. Methods: A retrospective single-center, cohort study of children referred for endoscopy with suspected CD during 2011–2014. We retrieved the clinical data, blindly reviewed duodenal biopsies, and performed immunohistochemical staining for anti-tTG deposits. Patients were classified as monosymptomatic or polysymptomatic. Mucosal anti-tTG deposits were classified according to the location of deposits, dominant intensity, maximal intensity, and percentage of stained area. Results: Of 252 patients with confirmed CD, complete data were available for 100: 37 males in the age range 1.3–16.7 with median 4.0 years. Monosymptomatic patients (n = 54) presented at an older age than polysymptomatic patients (1.3–15.5, median 8.1 vs. 1.3–16.7, median 6.3 years, p = 0.026). Marsh 2–3c was more prevalent in polysymptomatic patients (93 vs. 78%, p = 0.028). The intensity of mucosal anti-tTG deposits correlated with serum anti-tTG levels but not with the clinical presentation. Conclusions: Multiple symptoms and high serum anti-tTG antibody levels correlated with mucosal damage in children with CD. The role of immunohistochemical staining for intestinal anti-tTG mucosal deposits in the diagnosis of borderline CD is not yet established.

Download Full-text