Elevated Levels Of IgA Antibodies Research Articles

Тяжелое течение целиакии, осложненной стрессовой гипергликемией

This article presents a clinical case of lately diagnosed celiac disease complicated by stress-induced hyperglycemia. A 2-yearold patient was admitted to the intensive care unit of the Republican Specialized Scientific and Practical Medical Center of Pediatrics with severe protein-energy malnutrition, lethargy, abdominal bloating, and constipation. On admission, the child had hypoproteinemia, hypoalbuminemia, blood glucose levels up to 11.7 mmol/L, and anemia. On the third day of illness, blood glucose levels reached 16 mmol/L, which was considered as stress-induced hyperglycemia. Glucose levels were reduced by insulin injections on day 9. Celiac disease was suspected based on complaints, anamnestic, clinical and laboratory findings. Examination revealed elevated levels of IgA antibodies to tissue transglutaminase, exceeding the reference values 15 times. Genetic study confirmed the presence of predisposition to the disease. Catamnestic follow-up demonstrated a positive effect of a gluten-free diet. This is the first description of a typical form of celiac disease with late diagnosis and complications such as stress-induced hyperglycemia, respiratory failure, protein-energy malnutrition, and protein-losing enteropathy. Early diagnosis is very important to prevent long-term complications. Key words: children, malabsorption, celiac disease, stress hyperglycemia, protein-losing enteropathy

2640 Intractable Celiac Disease in IgA Deficiency

INTRODUCTION: Celiac disease is an immune-mediated disorder triggered by a reaction to gluten with elevated levels of IgA antibodies. Symptoms typically resolve with a gluten free diet. However, refractory cases have been reported despite dietary adherence. Our discussion involves an elderly woman with severe, refractory celiac disease with concomitant IgA deficiency. CASE DESCRIPTION/METHODS: An 80-year-old woman presented our clinic with exacerbation of chronic, non-bloody diarrhea. She has a history of celiac disease diagnosed 20 years ago after an episode of acute pancreatitis. She also has IgA deficiency and her total IgA level remains low at 37, despite infusions 3 times per week. She is strictly adherent to a gluten free diet, but continues to have multiple episodes of diarrhea and has lost over 100 pounds since her diagnosis. Patient had bidirectional endoscopy notable for antral gastropathy as well as fissures and flattening of the duodenal mucosa. Biopsies were consistent with celiac sprue. Capsule endoscopy showed diffuse flattening of the small bowel villi with erythema and cracked, scalloped mucosa as well as multiple, small, aphthous ulcers throughout the bowel (Figures 1, 2, and 3). Patient has had an extensive workup, but everything else have been unrevealing. Steroids have been initiated as a last-ditch effort, but she continues to have “more bad days than good days” despite being on a high dose prednisone. DISCUSSION: The diagnosis and treatment of celiac disease can be complicated by coexisting immunodeficiencies. Usually, titers of tissue transglutaminase IgA will be elevated and are involved in the immune reaction that causes damage to the lining of the small bowel with characteristic flattening of the villi as well as chronic diarrhea and malabsorption. A connection between IgA deficiency and celiac disease has been well established and likely contributes to the refractory nature of our patient’s disease. In patients with IgA deficiency it is important to utilize other forms of serologic testing, typically with IgG tissue transglutaminase, in addition to duodenal biopsies. Symptoms typically resolve with a gluten free diet. However, refractory cases have been reported with persistent diarrhea and villous atrophy for over 1–2 years. Symptom management can be difficult for these patients and may require the use of steroids as the last resource.

Chlamydia pneumoniae and severity of asthma.

A substantial increase in the prevalence of asthma in the Western world during the last few decades has led to a continuous search for novel factors that might be involved in the development of the disease. We carried out a study to clarify whether there is a relationship between severity of asthma and Chlamydia pneumoniae-specific titres at the group level and whether antibodies to the 60 kDa chlamydial heat shock protein (chsp60) are associated with asthma. A total of 116 (31 men, 85 women) consecutive asthma patients from a chest clinic were recruited and divided into 3 groups according to the severity of the disease: there were 13 asthmatics with severe, 54 with moderate and 49 with mild asthma. In addition, 50 (31 men, 19 women) consecutive blood donors were enrolled to serve as a control group. Sera for the measurements of specific IgG, IgA and IgM antibodies using a microimmunofluorescence test and of chsp60 using an enzyme immunoassay were obtained upon enrolment and also 3-4 months later from the asthma patients. Severe and moderate asthma were found to be strongly associated with elevated IgA antibody levels to C. pneumoniae [odds ratio (OR) 5.58, 95% confidence interval (CI) 1.31-23.72 for severe and OR 5.65, 95% CI 2.05-15.53 for moderate asthma] in a logistic regression model. Furthermore, in women, the occurrence of elevated IgA antibody levels and the age-adjusted geometric mean titres of IgA antibodies were significantly higher among the asthmatics than the controls (p = 0.003 and 0.04, respectively). Antibodies to chsp60 occurred more frequently and in higher concentrations among the asthmatics than the controls, although the differences did not reach significance. In conclusion, severe and moderate asthma were significantly associated with elevated IgA antibody levels to C. pneumoniae suggestive of chronic infection. Antibodies to chsp60 did not prove to be a useful marker of such an infection among the asthmatics studied here.

Anti-Beta 2-Glycoprotein I Antibody Isotype and IgG Subclass in Antiphospholipid Syndrome Patients

Beta 2-glycoprotein I (β2-GPI) is an antigenic target recognised by antiphospholipid antibodies found in association with the antiphospholipid syndrome (APS). In this study, the prevalence of Immunoglobulin M (IgM) and IgA anti-β2-GPI antibodies was examined in APS patients and compared with IgG antibodies. In addition the value of measuring antibody isotypes and IgG subclass was investigated in the laboratory diagnosis of APS. A solid phase enzyme linked immunosorbent assay was established to measure IgG, IgM and IgA and IgG subclass antibodies to β2-GPI in patients with APS and a variety of other thrombotic and non-thrombotic disorders. Raised levels of IgM anti-β2-GPI antibodies were observed in 65% of patients with APS, 21% with systemic lupus erythematosus (SLE), 23% with rheumatoid factor, 4% with stroke, 5% carotid artery stenosis (CAS), 17% with a biological false positive serology for syphilis, 43% with infectious mononucleosis (IM) and 27% with human immunodeficiency virus (HIV). The median value for IgM antibodies to β2-GPI for all these groups ranged from 2 to 7 arbitrary units (AU). Elevated levels of IgA antibodies to β2-GPI were found in patients with APS (47%), SLE (13%), rheumatoid factor (26%), CAS (48%), stroke (25%), VDRL false positive serology for syphilis (33%), IM (47%) and HIV (7%). The median value of IgA antibodies to β2-GPI in all of these groups ranged from 2 to 4 AU. Conversely the median value for IgG anti-β2-GPI in APS patients was 112 AU compared to 1-4 AU in the other conditions examined. The presence of IgM and IgA antibodies to β2-GPI was much less specific and sensitive for APS than IgG, with raised levels of these isotypes seen in a variety of thrombotic and non-thrombotic disorders. Elevated levels of IgG1, IgG2, IgG3 and IgG4 antibodies to β2-GPI were detected in APS patients. While all four IgG anti-β2-GPI antibody subclasses were represented in APS patients there appeared to be a significant overall skewing towards to the lgG2 subclass.

Urine patterns, peptide levels and IgA/IgG antibodies to food proteins in children with dyslexia.

There is an association between psychiatric disorders and dyslexia. In some psychiatric disorders abnormal urinary peptide patterns and peptide levels, and elevated levels of IgA antibodies to food proteins have been detected. These abnormalities are probably due to insufficient breakdown of the proteins gluten and casein. The aim of this study was to discover whether such abnormalities could be found in urine samples and serum of children with dyslexia. After screening 291 pupils in the fourth grade, 15 dyslexics and 15 controls were pairwise matched by gender, age, and cognitive level. Word decoding, spelling, and short-term memory tests were carried out, and information on handedness, immune and other disorders was obtained. Analyses of 24-h urine samples and of serum were performed. The reading abilities significantly differentiated the groups, and significant differences were found in frequency of left-handedness, immune disorders and other disorders. Three dyslexic children had elevated IgA antibodies. Two of these had positive endomycium tests, and coeliac disease was confirmed by biopsy. One had antibodies to proteins in milk. Our findings may suggest weak urinary peptide abnormalities in the dyslexic children, and they show significant differences in levels of IgA of antibodies to food proteins.

Detection and prevalence of the “f” variant of epstein-barr virus in Southern China

The “f” variant of Epstein-Barr virus (EBV) may have an association with the development and/or maintenance of nasopharyngeal carcinoma (NPC) among Southern Chinese. This variant is detected at a higher frequency among individuals with elevated IgA antibody levels against EBV capsid antigen who have no detectable NPC and in NPC patients as compared to healthy individuals or patients who are in remission for NPC for over 3 years. Conversion or replacement of the f variant by the prototype BamHI F virus usually occurs by 3 to 4 years after radiotherapy. By 5 years post-therapy the majority of people in remission for NPC no longer harbor the f variant in their oropharynx. Eradication of this f variant, however, does not appear essential for maintenance of a disease-free state since several patients harboring this variant were in remission for NPC for up to 21 years. The virus strain detected directly in the nasopharynx is not always identical to that seen in the oropharynx. Dual infection was commonly observed in throat washings of NPC patients although the biopsy from tumors harbored unique strains of EBV.

HUMORAL IMMUNITY AGAINST VIRAL ANTIGENS IN TYPE 1 DIABETES: ALTERED IgA‐CLASS IMMUNE RESPONSE AGAINST COXSACKIE B4 VIRUS

A group of 210 pediatric Type 1 diabetic patients with long duration of illness and their matched controls (age range 2-19 years) were analysed for Coxsackie B4 antibodies in IgG-, IgM- and IgA-antibody classes by enzyme-linked immunosorbent assay (ELISA). About 60% of both patients and controls were seropositive. However, patients had higher prevalence and mean levels of IgA-class antibodies compared to controls. No such difference was found in IgG- or IgM-antibody classes. The elevation of IgA-class antibody levels was evident early after the Coxsackie B4 infection and seemed to persist for several years. IgA-class antibody levels did not differ between sexes in either patients or controls. The elevated levels of IgA-antibodies against Coxsackie B4 virus did not correlate with the elevated IgA antibodies against mumps virus, which served as control antigens. Thus it seems that in IDDM patients the abnormal IgA response against both Coxsackie B4 and mumps virus is antigen-specific.

Preliminary study on the follow-up observations of the antibodies and circulating antigens in canine toxocariasis

In the sera of dog fetuses and newborn puppies, no antibody to Toxocara canis was found but an elevation of the circulating toxocaral antigens (CTA). In the mother dogs, detectable IgG and IgM antibodies were found. The IgG antibodies gradually increased in the course of this observation. The most elevated levels of IgA antibodies were observed one month after birth. The same was true for the CTA levels. There was no placental transfer of the antibodies nor could they be transferred from the mother dog to the offspring via the colostrum.

The IgA antibody activities in relation to the parasitologic status of toxocara canis in dogs

In this study, the relationship between the IgA antibody activities to Toxocara canis infection in dogs and their parasitologic status has been examined. The enzyme-linked immunosorbent assay was applied to the sera of dogs for the detection of the specific IgA antibodies and at the same time, autopsy and stool examination were performed on these dogs. The most elevated IgA antibody levels were observed in the one-month age group of puppies. Thereafter, the levels gradually decreased until six and 10 months of age. These low levels were maintained in adult dogs. However, the IgA antibody activities were not related to the age and the number of worms when the correlation coefficients were calculated. It was suggested from the results obtained that the elevated IgA antibodies at one month of age may have been due to the locally stimulated immunitiy by the adult worms grown up in the intestines and as a result, could be detected in the circulation.

Epstein-barr virus-specific serodiagnostic tests in carcinomas of the head and neck

Sera from 256 patients with cancers of the head and neck were examined for their profiles of IgG and IgA antibodies to Epstein-Barr virus (EBV)-specific, viral capsid antigen (VCA), the diffuse (D) and the restricted (R) components of the early antigen (EA) complex, and the EBV-associated nuclear antigen (EBNA), in order to assess the value of these procedures in the routine diagnosis of poorly or undifferentiated nasopharyngeal carcinoma (NPC). In 13 NPC patients, the carcinoma had invaded cervical lymph nodes, and their sera revealed, in addition to high IgG anti-VCA titers, elevated levels of IgA antibodies to VCA, of IgG antibodies to D, and most also had IgA anti-D. Such profiles were seen in very few of the patients with carcinomas at other sites of the head and neck. They had not developed in four NPC patients whose tumors were limited to the postnasal space, and in three patients with other tumors at that site. Among 15 patients with cervical node metastases from occult primary tumors, 2 had EBV-specific antibody profiles compatible with NPC, 1 was judged to have NPC on clinical grounds, and the other died of a pulmonary carcinoma, or possibly pulmonary metastases. In 4 of the remaining 13 patients with occult tumors, the primary site was found outside the nasopharynx, whereas it escaped detection in the other 9. These results lend further support to the usefulness of the EBV-specific serology to clinicians in the diagnosis of NPC, especially in cases of lymph node invasion by undetected primary tumors. The data also emphasize the need of complementing the serology with the examination of biopsies for the presence of EBV deoxyribonucleic acid (DNA) or, more readily performed, EBNA-positive carcinoma cells.

Significance of elevated IgA antibody levels in neonates withgastrointestinal conditions

Four groups of patients, 21 neonates with gastrointestinal anomalies, 8 with necrotizing enterocolitis, 5 with low anorectal anomalies and 15 with spina bifida were studied for the development of IgA and IgA subclass immunoglobulin levels. A highly significant increase in IgA levels (p less than 0.001) was seen in neonates with gastrointestinal anomalies and necrotizing enterocolitis while patients with low anorectal anomalies and spina bifida had normal or undetectable IgA levels. Estimation of IgA sub-class distribution in neonates with raised total serum IgA did not demonstrate any striking correlation between either IgA1 or IgA2 sub-classes and the clinical conditions but rather they reflected the level of total IgA. The levels if IgA, correlated closely with those of total IgA (r = 0.93) in all patients implying that in these patients total serum IgA is composed principally of IgA1 immunoglobulin.

Elisa studies in ankylosing spondylitis.

Specific IgA antibodies were measured by ELISA against Klebsiella, E. coli and Candida antigens in five different groups: active ankylosing spondylitis (high ESR), inactive ankylosing spondylitis (normal ESR), healthy controls, psoriasis and rheumatoid arthritis. Elevated levels of IgA antibodies against Klebsiella were found only in active ankylosing spondylitis patients.