Celiac sprue: Another autoimmune syndrome associated with hepatitis C

Fine, Kenneth D.; Ogunji, F. O.; Saloum, Yasser; Beharry, Shari L.; Crippin, Jeffrey S.; Weinstein, Jeffrey

doi:10.1016/s0016-5085(00)84919-7

Cited by 7 publications

(10 citation statements)

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“…Furthermore, only patients with hepatitis C (n=3; 1.2%) and autoimmune liver disease (n=2; 3.4%) presented positive EMA or TTG results. Also, one of the healthy volunteers showed positive anti-gliadin antibody, EMA and TTG results, and this individual was later diagnosed with hepatitis C 29 . Ruggeri et al assessed 244 patients with HCV infection (HCV-RNA positive) and 121 patients with HBV for the presence of TTG antibodies (the positive patients were additionally tested for EMA) and compared the results to those of 1,230 blood donors screened for celiac disease.…”

Section: Discussionmentioning

confidence: 94%

Autoantibody profile in individuals with chronic hepatitis C

Marconcini

Fayad

Shiozawa

et al. 2013

Rev. Soc. Bras. Med. Trop.

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Introduction: Autoantibodies are often produced during infection with chronic hepatitis C virus (HCV), but it remains controversial whether they influence the biochemical profile and histological features of this disease. Therefore, this current study sought to describe these autoantibodies and evaluate their impact on the clinical and histological presentation of hepatitis C. Methods: This cross-sectional analytical study assessed patients with HCV (RNA+) from October 2011 to July 2012. Results: This study included 66 patients, with a mean age of 53.2±10.5 years. Of these patients, 60.6% were male, and 54.3% presented with genotype 1. Non-organ-specific autoantibodies (NOSA) were detected in 24% of the patients; of these, 7.6% were anti-mitochondrial antibodies (AMA+), 26.7% were anti-smooth muscle antibodies (SMA+) and 6.8% were liver kidney microsomal type 1 antibodies (LKM1+). With respect to the thyroid autoantibodies, 7.4% were anti-peroxidase (ATPO+) antibodies, and none were anti-thyroglobulin (ATG+) antibodies. Regarding celiac disease autoantibodies, 5.8% were endomysial antibodies (EMA+), and no transglutaminase (TTG+) antibodies were detected. Cryoglobulins were found in 2.1% of patients. When NOSA+ individuals were compared to patients without the presence of NOSAs, they exhibited higher median alkaline phosphatase (0.7 vs. 0.6 xULN; p=0.041), lower median platelet counts (141,500.0 vs. 180,500.0/mm 3 ; p=0.036), lower mean prothrombin activity (72.6±11.5% vs. 82.2±16.0%; p=0.012) and an increased prevalence of significant fibrosis (E≥2) (45.5% vs. 18.2%; p=0.012). There was also a tendency for a greater proportion of NOSA+ cases to have marked periportal activity (APP≥3) (44.5% vs. 15.6%; p=0.087). Conclusions: In addition to the high prevalence of autoantibodies associated with HCV infection, it was observed that NOSA positivity was associated with a more severe histological and biochemical profile of hepatitis C infection.

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Section: Discussionmentioning

confidence: 94%

Autoantibody profile in individuals with chronic hepatitis C

Marconcini

Fayad

Shiozawa

et al. 2013

Rev. Soc. Bras. Med. Trop.

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“…Liver involvement in CD and the ultimate diagnosis of occult CD in cases of chronic cryptogenic liver disease is well documented (5,15,22,26). However, the association of CD with chronic hepatitis C is controversial (16,40,45,47). Fine et al (16) argued that celiac sprue is another autoimmune syndrome associated with HCV infection and that HCV acts as a triggering stimulus for the immunologic reactions characterizing celiac sprue in genetically predisposed individuals.…”

Section: Discussionmentioning

confidence: 99%

“…However, the association of CD with chronic hepatitis C is controversial (16,40,45,47). Fine et al (16) argued that celiac sprue is another autoimmune syndrome associated with HCV infection and that HCV acts as a triggering stimulus for the immunologic reactions characterizing celiac sprue in genetically predisposed individuals. The same study reported a CD prevalence of 1.2% in HCV patients, which is in agreement with our findings.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

Germenis

Yiannaki

Zachou

et al. 2005

Clin Vaccine Immunol

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The prevalence of celiac disease (CD) and the prevalence and clinical significance of anti-tissue transglutaminase (tTG) antibodies (tTGAbs) in a large series of patients with chronic liver diseases were assessed. We studied 738 patients (462 with chronic viral hepatitis, 117 with autoimmune liver diseases, 113 with alcoholic or nonalcoholic fatty liver disease, and 46 with other liver disorders) and 1,350 healthy controls (HC). Immunoglobulin A (IgA) tTGAbs were measured by enzyme-linked immunosorbent assay and a microspherebased flow cytometric assay. Positive sera were investigated for IgA antiendomysial antibodies (EmA). IgA tTGAb-positive subjects were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Four of 1,350 HC (0.3%) tested tTGAb ؉ EmA ؉ and underwent a biopsy (CD confirmation in all). Four of 738 liver disease patients tested tTGAbs ؉ EmA ؉ (0.54%; not statistically significant). Two were HCV infected (1.24%; not statistically significant), and two had transaminasemia of unknown origin. Forty-three patients tested tTGAbs ؉ EmA ؊ (5.8%; P < 0.001 compared to HC). Inhibition experiments verified the existence of specific IgA anti-tTG reactivity. Twenty-six of 43 patients underwent a biopsy (all negative for CD). Binary logistic regression analysis revealed age (P ‫؍‬ 0.008), cirrhosis (P ‫؍‬ 0.004), alkaline phosphatase (P ‫؍‬ 0.026), and antinuclear antibodies (P ‫؍‬ 0.012) as independent risk factors for tTGAb reactivity among the patients. It was concluded that CD prevalence is the same in HC and patients with chronic liver diseases. The prevalence of tTGAbs is higher in hepatic patients compared to HC, but their specificity for CD diagnosis in this group of patients is low. tTGAbs in patients appear to be associated with the presence of autoimmunity, cirrhosis, and cholestasis, irrespective of the origin of the liver disease.Over the past few years, the identification of tissue transglutaminase (tTG) as the main, if not the sole, autoantigen recognized by antiendomysial antibodies (EmA) in celiac disease (CD) patients (12) allowed an increased number of asymptomatic and oligosymptomatic patients to be diagnosed and numerous associations of the disease with a range of conditions to be unveiled (15). Despite, however, the fact that the association between CD and various hepatic diseases has been extensively investigated (8, 9, 11, 16-19, 23, 26, 40, 41, 43, 45, 47, 48), a definite correlation between these pathological conditions has not been unequivocally established.Conflicting results have been reported that, at least in part, can be attributed to differences in the performance of serological tests used by different investigators for initial screening for CD. Patients with chronic liver diseases frequently have immunological and other disturbances, like hypergammaglobulinemia, that might interfere with the detection of serological markers for CD. Another reason underlying the discordant data may be related to the emergence of anti-tTG antibodies in some patients with chronic...

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“…58 The diagnosis of CD was confirmed with duodenal biopsy; all of those patients had mild intestinal symptoms and carried the HLA-DQ2 allele. 58 Another study showed a CD prevalence of 1.3% in a series of 534 patients affected by chronic hepatitis C. 59 A recent study of patients having both CD and chronic hepatitis C described a well-defined route of transmission in most of these subjects, raising the hypothesis that the link between these two diseases is probably biased by the route of transmission of hepatitis C infection. 60 Thus, a clear association of CD and chronic hepatitis C is lacking.…”

Section: Viral Hepatitismentioning

confidence: 90%

The liver in celiac disease

2007

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Celiac disease is a common (1% prevalence) chronic immune-mediated disorder of the small intestine induced by dietary wheat, barley, and rye. Several hepatic disorders have been described in association with celiac disease. Isolated hypertransaminasemia with nonspecific histologic changes in a liver biopsy is the commonest hepatic presentation of celiac disease. A gluten-free diet normalizes liver enzymes and histologic changes in most patients. Moreover, celiac disease can coexist with autoimmune liver disorders such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Celiac disease has increasingly been reported with a variety of other liver diseases. Thus, the hepatologist needs to consider celiac disease in the differential of abnormal liver blood tests and to be aware of the clinical implications of this frequent disease in patients with liver disorders. The possible mechanisms of liver injury and those common factors that explain the association of celiac disease with liver disorders are discussed. The aims of this article are (1) to review the spectrum and pathogenesis of liver injury related to celiac disease and (2) to provide direction to those caring for patients with chronic liver diseases regarding the detection and effective treatment of celiac disease. (HEPATOLOGY 2007;46:1650-1658

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Celiac sprue: Another autoimmune syndrome associated with hepatitis C

Cited by 7 publications

References 0 publications

Autoantibody profile in individuals with chronic hepatitis C

Autoantibody profile in individuals with chronic hepatitis C

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

The liver in celiac disease

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