Assessing possible celiac disease by an HLA-DQ2-gliadin Tetramer Test

• Published in: The American journal of gastroenterology Vol. 106; no. 7; p. 1318
• Main Authors: Brottveit, Margit, Ráki, Melinda, Bergseng, Elin, Fallang, Lars-Egil, Simonsen, Bjørg, Løvik, Astrid, Larsen, Stig, Løberg, Else Marit, Jahnsen, Frode L, Sollid, Ludvig M, Lundin, Knut E A
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.07.2011
• Subjects: Adolescent; Adult; Aged; Biopsy; Bread; CD4-Positive T-Lymphocytes - immunology; CD4-Positive T-Lymphocytes - metabolism; Celiac disease; Celiac Disease - blood; Celiac Disease - diagnosis; Celiac Disease - immunology; Celiac Disease - pathology; Diagnostic Techniques, Digestive System; Endoscopy, Digestive System; Female; Flow Cytometry; Gastroenterology; Gastrointestinal Tract - immunology; Glutens - immunology; HLA-DQ Antigens - immunology; HLA-DQ Antigens - metabolism; Humans; Male; Middle Aged; Young Adult
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.1038/ajg.2011.23

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. 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. 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. 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%.