Total Serum IgA Levels Research Articles

Total serum IgA levels and HLA-DQB1*02:01 allelic status.

Immunoglobulin A Deficiency (IgAD) is the most common primary immunodeficiency and issignificantly associated with Celiac Disease (CD), which recognizes a specific background ofhuman leukocyte antigens (HLA) predisposition (including HLA-DQB1*02:01 allele). A numberof studies investigated the role of HLA in IgAD etiopathogenesis: HLA-DQB1*02 alleles areincluded in the main haplotypes linked to this primary immunodeficiency. In this preliminarystudy, we investigated the potential impact of HLA-DQB1*02:01 allelic status on total serum IgAlevels: 108 serum samples from the bone marrow donors' registry wereanalyzed for total IgA concentration with respect to the HLA-DQB1*02:01 status. Although totalserum IgA levels between HLA-DQB1*02:01 carriers and HLA-DQB1*02:01 negative donorswere not different, we observed a statistically significant difference (p=0.0118) in total serum IgAlevels among donors with low IgA concentration (<80mg/dL) in the sub-analysis between HLA-DQB1*02:01 positive group (including both homozygous and heterozygous carriers) compared toHLA-DQB1*02:01 negative donors. Our results might suggest a role of HLA-DQB1*02:01 allelicvariant in the determination of total serum IgA levels, at least in patients affected with IgAdeficiency and/or otherwise predisposed to it; however, larger and more standardized studies areneeded to confirm this speculation.

Comparison of Serum Total IgA Levels in Severe and Mild COVID-19 Patients and Control Group.

BackgroundThe present study aimed to compare serum total IgA levels between severe and mild COVID-19 patients’ groups and the control group.MethodsIn this cross-sectional study, 216 definite severe COVID-19 patients (as the inpatient group), 183 subjects with positive specific COVID-19 IgG with mild or no symptoms as the (outpatient group), and 203 healthy subjects with negative specific serology, as the control group were investigated. The cases’ laboratory data were collected, and thereafter, statistical tests, including independent samples t test, ANOVA test, and post hoc test, were performed using SPSS software version 22.ResultThe mean ± SD of IgA in all the included subjects was 2.23 ± 0.78 (g/L). According to the obtained results, there were statistically significant changes in IgA among the three study groups (P value < 0.05). This difference was significant between both outpatient and inpatient groups (P value < 0.05). The mean ± SD of serum IgG in all the subjects was calculated as 15.83 ± 5.73 (g/L). A strong statistically significant change was also seen in IgG among all three groups (P value < 0.001). Of note, there was a significant negative correlation between IgG and IgA total titers of the outpatient group (P value = 0.011*r = − 0.188).ConclusionIt was shown that the total serum IgA and IgG levels are significantly associated with the severity of COVID-19 infection. As well, we found that total serum IgA and IgG are associated with the severity of illness. Since a low level of IgA is asymptomatic and high frequent in Iran and other countries, we suggest the evaluation of serum IgA levels in high-risk people and strengthening immune system in subjects with a low level of IgA, in order to reduce the rate of death. In this regard, oral or nasal mucosal vaccines in combination with parenteral vaccination are recommended due to increasing immunity versus COVID-19 by further secretion of the IgA antibody and preventing virus transmission.

Carbamazepine-Induced Hematological and Immunological Alterations in Egyptian Children with Idiopathic Generalized Seizures

AbstractCarbamazepine (CBZ) is one of the oldest antiepileptic drugs (AEDs) that is still used for the treatment of tonic-clonic seizures in children. Long-term use of AEDs induces potential toxic effects that may remain undetermined for a long time. Earlier studies have revealed a wide spectrum of hematological toxicities associated with CBZ. This study was conducted to unveil the toxic effects of carbamazepine as an antiepileptic monotherapy on hematological and immunological parameters in a group of Egyptian pediatric patients using it for different durations. Fifty pediatric epileptics of either sex were enrolled; 38 were taking CBZ as antiepileptic monotherapy for ≥ 6 months and 12 were newly diagnosed untreated patients. Hematological and immunological parameters studied were compared with their age and sex-matched 15 controls and among groups. CBZ was found more toxic for total leukocyte count, lymphocyte count, serum IgA and IgM levels (p &lt; 0.001, 0.001, &lt; 0.001, &lt; 0.001, respectively). Hemoglobin level, platelets count, serum C4 level and IgA were negatively correlated with serum CBZ level (Spearman's rho = – 0.62, – 0.42, – 0.34, – 0.13; p &lt; 0.001, 0.008, 0.04, 0.44, respectively). CBZ treatment duration associated inversely with platelets, lymphocyte, and eosinophil counts (p &lt; 0.001, 0.03, 0.01, respectively). Epileptic children on CBZ monotherapy had their hematologic and immunologic systems affected, which mandates routine monitoring of these children.

Current status of the acquired immune system of Iranian patients with long-term complications of sulfur mustard poisoning.

Sulfur mustard (SM) is a powerful blistering chemical warfare agent that has genotoxic effects. Cells with excessive proliferation such as lymphocytes may inherit this cellular toxicity which can lead to their malfunctions in the long-term. This study was designed to evaluate the status of acquired immunity among SM poisoned veterans around three decades after exposure. Thirty five male Iranian veterans having at least 25% disability due to SM poisoning with long-term complications in the respiratory system, skin or eyes were investigated. Non-functional/functional tests including hematological parameters, immunostaining analysis, lymphocyte proliferation assay, cytokine profile, and levels of total serum IgM, IgG and IgA were performed. The results showed that most of the parameters of adaptive immune system of the veterans were currently within the normal ranges. However, changes in the proliferation index (PI) of lymphocytes showed problems with the lymphocytes which cannot be proliferated appropriately. PI values for PBMCs (peripheral blood mononuclear cells) in presence of PHA (Phytohemagglutinin-A) and LPS (lipopolysaccharide) mitogens were 1.16 ± 0.14 and 1.13 ± 0.07, respectively which are less than expected. Based on the results gathered in this study, most of the parameters of acquired immunity were normal. However, the observed failure of lymphocyte functions may disrupt physiological activity of whole immune system leading to long-term complications; including recurrent respiratory tract infections. Indeed, further cellular and molecular studies with regard to lymphocytes function are required to better understand the status of adaptive immunity in these patients. Graphical abstract ᅟ.

A Comparative Evaluation of Serum and Salivary Total Proteins and Immunoglobulins in Patients with Hepatitis A and Healthy Subjects

Assessment of changes in total proteins level, serum and saliva IgG and IgA levels, serum IgM level, serum and saliva IgA/IgG ratio. The study was conducted on a group of 40 subjects, divided into 2 lots: the first lot consisting of 20 healthy individuals and the second consisting of 20 patients with hepatitis with hepatitis A virus (HAV). The levels of total proteins, serum and saliva IgG and IgA, serum IgM and serum and saliva IgA/IgG ratio have higher values in patients with hepatitis A, in comparison to healthy subjects, without necessarily exceeding the maximum admitted value. The results are significant from a statistical point of view. Due to the sensitivity and specificity of salivary anti-HAV IgM and IgG in patients with acute hepatitis A, compared with healthy subjects, there is a possibility of using salivary immunological tests instead of serum tests for the diagnosis and epidemiological study of HAV infection.

Aryl hydrocarbon receptor activation fails to alter Cholera toxin-specific fecal IgA secretion after oral immunization in mice.

Abstract Secretory IgA plays a critical role in neutralizing enteric toxins and protecting against some intestinal pathogens. In mice, activation of the aryl hydrocarbon receptor (AhR) with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has been shown to suppress antigen-specific systemic IgM and IgG responses, whereas the impact of AhR activation on mucosal IgA responses is less clear. The goal of this study was to determine if TCDD exposure could alter fecal levels of antigen-specific IgA after oral immunization. Female C57Bl/6 mice were administered peanut oil (vehicle) or TCDD (10 μg/Kg, po), and, on the following day, each animal was immunized with whole Cholera toxin (CT, 10 μg, po) with two subsequent immunizations being given at 10 day intervals. Antibody levels were measured by ELISA in fecal extracts each week (normalized to protein) and in serum at termination (week 4). We found that total serum IgA levels were significantly decreased (P &amp;lt; 0.05) in TCDD-treated animals, relative to controls. In contrast, no change in total fecal IgA levels was observed in TCDD-treated mice at any time point measured (weeks 1–4). Interestingly, no change in CT-specific serum IgA levels was observed in TCDD-treated mice, whereas TCDD exposure significantly decreased (P &amp;lt; 0.05) CT-specific serum IgG1 and IgM levels. In Feces, as in serum, no change in CT-specific IgA levels was found in TCDD-treated mice at any time point measured (weeks 3–4). These results suggest that intestinal IgA responses are not adversely impacted by TCDD exposure, an observation that markedly contrasts with the suppression of systemic antibody responses widely seen in animals after TCDD treatment.

Restoration of Retarded Influenza Virus-specific Immunoglobulin Class Switch in Aged Mice.

ObjectiveThe declined immune response to infection causes significant higher morbidity and mortality in aging in spite of the coexisted hyperimmunoglobulinemia (HIG). This study is to reveal the cellular basis of HIG and mechanism of weakened HA-specific IgG response in aged mice and to test cell therapy in the treatment of age-related IgG antibody production deficiency with immunocyte adoptive transfer.MethodsBALB/c mice was immunized with Influenza A/Taiwan vaccine and challenged with the same strain of virus. ELISA was used to assess the levels of total immunoglobulins and antigen specific antibody response. The flow cytometry and ELISPOT were used to evaluate the frequencies of total immunoglobulin- and specific antibody-producing and secreting B lymphocytes. In vitro expanded mononuclear cells, CD4+ T lymphocytes and CD20+ B lymphocytes from old and young mice were adoptively transferred into influenza virus-challenged aged mice, and HA-specific IgG responses were observed.ResultsIt is found that old mice exhibited higher levels of total serum IgG, IgM and IgA, higher frequencies of IgG+, IgM+ and IgA+ cells, and greater antigen-specific IgM and IgA responses to influenza infection, in comparison to young mice. However, influenza antigen- specific IgG and its subclass responses in old mice were significantly lower.ConclusionThe retarded specific IgG response could be attributed to an insufficiency of immunoglobulin class switch in aging. Correlation analysis indicated that HIG and deficient specific IgG production in aged mice could be independent to each other in their pathogenesis. Correction of deficient specific IgG production by adoptive transfer of in vitro expanded and unexpanded CD4+ cells from immunized young mice suggests the CD4+ cell dysfunction contributes to the insufficiency of immunoglobulin class switch in aged mice. The transfusion of in vitro expanded lymphocytes could be a potential effective therapy for the age-related immunodeficiency and could play a role in the infection prevention in aging.

Celiac Disease

On the basis of strong evidence, gastrointestinal symptoms and failure to thrive are classic presentations of celiac disease, but atypical, nongastrointestinal symptoms are also extremely common, particularly in the older child and adolescent. (3)(4)(8). On the basis of some research evidence and consensus, guidelines recommend celiac testing in symptomatic children with typical and atypical symptoms and consideration of testing in those with associated conditions and first-degree relatives of those with celiac disease. (3)(9). On the basis of strong research evidence, measurement of tTG IgA and total serum IgA level has been reported to be the most cost-effective and accurate means of serologic testing for celiac disease and is the test of choice unless the child is younger than 2 years or IgA deficient. (9). On the basis of strong research evidence, children with elevated titers of celiac antibodies or strong clinical suspicion for celiac disease should be referred to a gastroenterologist for upper endoscopy and biopsy. Until this procedure is performed, the child should continue on a diet with ingestion of gluten. (3)(9). On the basis of strong research evidence, all those with a confirmed diagnosis of celiac disease should follow a strict gluten-free diet for life, with avoidance of all foods that contain wheat, barley, and rye ingredients. (3)(4). Referral to a health care professional with specialized knowledge of celiac disease and the gluten-free diet is critical because of the numerous ways, often hidden, in which gluten may be present in the diet and environment.

The pathogenic role of Blastocystis isolated from patients with irritable bowel syndrome and colitis from Iasi, Romania.

Blastocystis is a common parasite and regarded as one of the etiologic agents of irritable bowel syndrome, colitis and chronic diarrhea. Our study was undertaken in order to identify different subtypes of Blastocystis isolated in patients with irritable bowel syndrome and colitis, as well as with chronic diarrhea and to evaluate their pathogenic potential. Seventy-three subjects (10 asymptomatic infected subjects, 49 subjects harboring Blastocystis or associated with other etiologic agents like bacteria, yeasts, protozoa, helminthes and 14 subjects with unknown etiologic agents) were investigated by in vitro parasitological and bacteriological stool samples followed by PCR subtyping of Blastocystis using STS primers, immunological markers (total serum IgA and IgE antibody levels), Helicobacter pylori antigen rapid test and fecal occult blood test. Also, among 49 subjects, there were 12 subjects harboring Blastocystis as the single etiologic agent. Subtyping proved that only three subtypes of Blastocystis were identified as following: subtype II (66.66%) in single infected subjects, subtype I (16.66%) in mixed infection with subtype II and subtype IV (8.33%) in single infected subjects. Total serum IgA and IgE antibody levels were in normal range. Subtype II was the most frequent subtype followed by subtype I and subtype IV of Blastocystis isolates in patients with irritable bowel syndrome, colitis, and chronic diarrhea as well as in asymptomatic infected group. Our results suggest that the severity of clinical manifestations depend on factors involving the host and possible parasitic density and not necessarily by isolated subtype.

Biomarkers in IgA nephropathy: relationship to pathogenetic hits.

IgA nephropathy, the most prevalent glomerular disease in the world, requires a renal biopsy for diagnosis. Reliable biomarkers are needed for the non-invasive diagnosis of this disease and to more fully delineate its natural history and risk for progression. In this review, the authors examine serum levels of galactose-deficient IgA1 (Gd-IgA1) and glycan-specific IgG and IgA autoantibodies that are integral to pathogenesis of IgA nephropathy. They also explore biomarkers related to alternative and lectin pathways of complement activation and serum and urinary peptide biomarkers detected by mass spectrometric methods. The literature search included review of all publications having IgA nephropathy in the title that were cited in PubMed and Scopus over the past 10 years and a non-systematic review of abstracts published for the annual meetings of the American Society of Nephrology and the International Symposia on IgA Nephropathy. Serum Gd-IgA1 level and glycan-specific autoantibody levels are prime candidates to become diagnostic biomarkers for IgA nephropathy because of their central role in the earliest stages of disease pathogenesis. Assays for serum levels of complement proteins C3 and factor H are readily available in clinical practice and deserve continued study, either alone or in tandem with total serum IgA or serum Gd-IgA1 levels, as prognostic biomarkers for patients with IgA nephropathy. Urinary peptidomic data are also reviewed because this approach can successfully differentiate patients with IgA nephropathy from healthy controls and from patients with other forms of renal disease.

Primary sclerosing cholangitis is associated with autoreactive IgA antibodies against biliary epithelial cells

Objective. Primary sclerosing cholangitis (PSC) is a chronic liver disease characterized by progressive destruction of the biliary tract system. Autoimmune reactions have been suggested to play a role in the etiology and pathogenesis of PSC, and a large number of different autoantibodies have been reported in PSC patients. However, the role of IgA, being the dominant immunoglobulin in bile and transported there via biliary epithelial cells, is still incompletely understood in PSC. The aim of this study was to evaluate the presence of autoreactive IgA in PSC patients. Material and methods. Cultures of biliary epithelial cells from healthy human liver tissue were established. Serum was collected from a total of 81 PSC patients and 42 healthy controls and tested for reactivity against biliary epithelial cells using flow cytometry. Patient characteristics were correlated with experimental findings. Results. The results showed that a majority of investigated PSC patients had autoreactive IgA against biliary epithelial cells, whereas these antibodies were almost absent in healthy individuals. Presence of autoreactive IgA in the PSC patients was not associated to gender, age, duration of disease, concomitant inflammatory bowel disease, or cholangiocarcinoma. Instead, the levels of autoreactive IgA correlated with higher total serum IgA levels and autoreactive IgA-positive patients progressed faster to a clinical endpoint (death or liver transplantation) compared to autoreactive IgA-negative patients. Conclusions.The findings provide new insights into the role of IgA in PSC patients and opens up for future studies addressing pathogenic mechanisms of autoantibodies directed against biliary epithelial cells.

Celiac Disease in Oman: A Tertiary Centre Experience

Celiac disease is an autosomal recessive autoimmune condition causing chronic inflammation of the small intestine triggered by ingestion of gluten. Clinical presentation of the disease could be either intestinal manifested mainly by abdominal pain and diarrhea or extra intestinal manifested by symptoms including rickets, dermatitis herpitoformis and infertility in adults. Celiac disease is ascertained by the presence of positive IgA of anti tissue transglutaminase (anti tTG) or anti endonysial anti bodies (anti EMA) in addition to histological changes on duodenal biopsy indicative of celiac disease with normal total serum IgA levels.1 The mass screening of four European populations reported in 2010 revealed a prevalence of 1%.2 Review of earlier studies conducted in Europe and United States indicates a prevalence ranging from 3 to 13 per 1000 children between the age of 2.5 to 15 years.2,3 Information about celiac disease among Arab populations is sparse and based on small scale studies. A single centre in Egypt reported a frequency of 0.53% among children attending a general pediatric clinic and rises to 6.4% in children with type 1 diabetes mellitus.4 At King Abdul Aziz Medical centre in Saudia Arabia, only 80 patients were diagnosed over a 5 year period.5 A more recent study in adult blood donors in Saudia Arabia reported a prevalence of 1.5% among blood donors.6 In India, the frequency of encounter of celiac disease in different areas ranged from 0.3%,7 to an encounter of 1%.8 Data on celiac disease in Oman is limited to two studies conducted at Sultan Qaboos University Hospital between 2003,9and 2006.10 The screening of 51 adults with unexplained iron deficiency anemia attending Sultan Qaboos University Hospital by Fraser,9 revealed two cases of celiac disease based on anti EMA yielding a frequency of encounter of 3%. In 2006, Akinbami ascertained the disease among 13% out of 62 children with chronic diarrhea attending the same hospital.10 This study is aimed at updating information on celiac disease in Oman by providing a detailed review and description of the cases diagnosed in Royal Hospital as the main referral centre for work up of patients suspected to have celiac disease in Oman.

Chronic Diarrhea in Children

Chronic Diarrhea in Children

Effects of multistrain lactic acid bacteria with probiotic properties on enhancements of IgA, IgG levels and anti- Salmonella Typhimurium invasion activity

In our study, BALB/c mice were orally administered multistrain probiotics or sterile water for 28 consecutive days. The total serum IgA and IgG antibody levels were significantly higher in the group of mice administered probiotics (p ＜ 0.05) than in the control group at the 4^(th) week. Consumption of multistrain probiotics for 28 days significantly increased (p ＜ 0.05) the fecal populations of Bifidobacterium spp. and Lactobacillus spp. In another animal model, the mice were orally administered for 14 consecutive days. On the 7th day, all the mice were orally challenged with Salmonella Typhimurium ISM 50. The mice were sacrificed after 6 days of infection, Salmonella counts in the spleen and liver of the mice administered probiotics significantly declined (p ＜ 0.001) as compared to the control group. We demonstrated that the probiotic mixture could be used to enhance the host serum IgA and IgG levels and prevent Salmonella infection.

Serum IgA in Celiac Disease: The Unrecognized Importance of Partial IgA Deficiency

Background and Aims: The association between selective complete IgA deficiency (SIgAD) and celiac disease (CD) is well recognized. However, most data come from European pediatric populations. Given that the prevalence of immunoglobulin deficiency syndromes including SIgAD varies markedly in different populations, available data may not be representative of the adult celiac population in the United States. Our objective was to determine the distribution of SIgAD in an adult U.S. celiac population compared to controls. While, SIgAD precludes use of IgA serology, the effect of partial IgA deficiency (PIgAD) on IgA tTG test performance is unknown. Thus, our secondary aim is to assess the effect of PIgAD on serologic testing for untreated CD. Methods: In adults SIgAD is defined as a serum IgA concentration of less than 7mg/dl in the presence of normal levels of other immunoglobulins. PIgAD describes a low serum IgA of less than 70 but greater than 7mg/dlis. Total IgA was measured in patients undergoing tTG testing including patients with biopsy proven CD and an equal number of tTG negative disease controls with various GI disorders. Patients were classified as having CD if duodenal pathology showed a Marsh 2 or 3 lesion and there was either positive serology or histologic response to GFD, in the absence of negative CD genetic testing (DQ2/DQ8). Controls consisted of patients on a normal diet with negative IgA-tTG or IgGDGP, and without other diagnostic criteria for CD. Results: IgA data were available for 135 CD patients and 168 disease controls. 1.5% (2 of 135) CD patients had SIgAD compared to 0.6% (1 of 168) of controls (P=0.5). A further 3.7% of CD patients and 5.9% of disease controls had PIgAD. The median age at diagnosis for IgAD CD patients was 59 yr compared to 42 yr for CD patients with a normal IgA (p= 0.05). Pre-treatment tTG serology was negative in 100% (2 of 2) SIgAD CD patients. Of note, 40% (2 of 5) of the PIgAD CD group compared to 1.7% (2 of 117) of the non IgA deficient CD group had a negative tTG at diagnosis. Interestingly, all IgAD CD patients with an IgA level >50 mg/dl had positive IgA tTG results compared to 0 of 4 with IgA levels < 50 mg/dl. Conclusions: The incidence of SIgAD was 1.5% in our CD patients which is consistent with the European literature. IgA deficient patients were older, possibly representing an association between advancing age and IgA deficiency. The high prevalence of partial IgA deficiency in non-CD gastroenterology patients (5.9%) is novel, suggesting that IgA deficiency may be a risk factor for GI symptoms, via small intestinal bacterial overgrowth or other mechanisms. This finding warrants further study. IgG-based celiac serology testing should be considered for all patients with a total serum IgA level of less than 50 mg/dl.

Changes in Body Mass Index on the Gluten Free Diet: Risk of Obesity

Background and Aims: The association between selective complete IgA deficiency (SIgAD) and celiac disease (CD) is well recognized. However, most data come from European pediatric populations. Given that the prevalence of immunoglobulin deficiency syndromes including SIgAD varies markedly in different populations, available data may not be representative of the adult celiac population in the United States. Our objective was to determine the distribution of SIgAD in an adult U.S. celiac population compared to controls. While, SIgAD precludes use of IgA serology, the effect of partial IgA deficiency (PIgAD) on IgA tTG test performance is unknown. Thus, our secondary aim is to assess the effect of PIgAD on serologic testing for untreated CD. Methods: In adults SIgAD is defined as a serum IgA concentration of less than 7mg/dl in the presence of normal levels of other immunoglobulins. PIgAD describes a low serum IgA of less than 70 but greater than 7mg/dlis. Total IgA was measured in patients undergoing tTG testing including patients with biopsy proven CD and an equal number of tTG negative disease controls with various GI disorders. Patients were classified as having CD if duodenal pathology showed a Marsh 2 or 3 lesion and there was either positive serology or histologic response to GFD, in the absence of negative CD genetic testing (DQ2/DQ8). Controls consisted of patients on a normal diet with negative IgA-tTG or IgGDGP, and without other diagnostic criteria for CD. Results: IgA data were available for 135 CD patients and 168 disease controls. 1.5% (2 of 135) CD patients had SIgAD compared to 0.6% (1 of 168) of controls (P=0.5). A further 3.7% of CD patients and 5.9% of disease controls had PIgAD. The median age at diagnosis for IgAD CD patients was 59 yr compared to 42 yr for CD patients with a normal IgA (p= 0.05). Pre-treatment tTG serology was negative in 100% (2 of 2) SIgAD CD patients. Of note, 40% (2 of 5) of the PIgAD CD group compared to 1.7% (2 of 117) of the non IgA deficient CD group had a negative tTG at diagnosis. Interestingly, all IgAD CD patients with an IgA level >50 mg/dl had positive IgA tTG results compared to 0 of 4 with IgA levels < 50 mg/dl. Conclusions: The incidence of SIgAD was 1.5% in our CD patients which is consistent with the European literature. IgA deficient patients were older, possibly representing an association between advancing age and IgA deficiency. The high prevalence of partial IgA deficiency in non-CD gastroenterology patients (5.9%) is novel, suggesting that IgA deficiency may be a risk factor for GI symptoms, via small intestinal bacterial overgrowth or other mechanisms. This finding warrants further study. IgG-based celiac serology testing should be considered for all patients with a total serum IgA level of less than 50 mg/dl.

Assessing the prevalence of coeliac disease in patients with intellectual disabilities

Previous studies have suggested a high prevalence of coeliac disease in patients with intellectual disabilities (Nisihara et al, 2005; Shamaly et al, 2007). To further explore any possible relationship, 196 patients with intellectual disabilities were identified in rehabilitation centres in the province of East Azerbaijan in Iran. They were matched with 196 healthy controls and screened for coeliac disease. Anti-tissue transglutaminase IgA antibodies (tTGA) and total serum IgA levels were measured, and the Marsh-Rostami criteria used to evaluate histological findings. Two patients (1%) were positive for tTG and duodenal biopsies showed Marsh I in one patient and Marsh 0 in the other. IgA deficiency was detected in three patients in the study group and tTGA was positive in one individual. Biopsies from this patient showed Marsh IIIc. From the control group only one individual had positive tTGA and five cases were IgA deficient. Two of these patients had positive tTG but both had normal histology. Coeliac disease was not found to be more prevalent in patients with intellectual disorders which suggests that screening for coeliac disease in these patients would not be cost effective.

The Association Between Anti-endotoxin Antibodies And C Reactive Protein Levels And Fatal Outcome Among Patients Hospitalized In An Intensive Care Unit For Severe Gastrointestinal Diseases

RATIONALE: Bacteremia from the abdomenal diseases can lead to systemic exposure to endotoxin, a potent stimulator of immune inflammatory responses. Anti-endotoxin antibodies in serum may help prevent the consequences of systemic endotoxin exposure. This investigation assesses the relationship between anti-endotoxin antibodies and fatalities among intensive care unit patients with gastrointestinal disease. METHODS: 45 patients who were admitted to the intensive care department due to abdominal surgery complications, pancreatitis, peritonitis or sepsis were studied. Blood analysis included serum levels of C-reactive protein, Anti-endotoxin IgG, IgA and IgM antibodies determined by ELISA. Total serum IgG, IgA and IgM levels were also assessed. The patients were divided based upon the results of the hospitalization into: Group1 - 31 patients who survived; and Group 2 - 14 patients who died due to systemic multi-organ failure. RESULTS: In all patients from Groups 1and 2 the level of C-reactive protein in serum was increased, however it was 3.3 times greater in Group 2 than in Group 1 (p<0.001). Group 2 patients had levels of anti-endotoxin IgG antibodies which were 1.8 fold less than in Group 1 (p<0.05). The levels of total IgG, IgM and IgA did not differ significantly between the two groups. CONCLUSIONS: The circulatory disturbances within the gastrointestinal tracts of patients with severe acute inflammatory abdominal disease lead to enhanced bacterial translocation with endotoxin entering systemic blood flow. Increased levels of serum C-reactive protein, indicative of an acute inflammatory response and decreased levels of anti-endotoxin IgG antibodies, indicative of a reduced protective response, are associated with fatal outcomes.

Identification and Characterization of Two Distinct Bursal B-Cell Subpopulations Following Infectious Bursal Disease Virus Infection of White Leghorn Chickens

Infectious bursal disease virus (IBDV) is an immunosuppressive virus which primarily infects IgM B-cells in the bursa of Fabricius. Flow cytometric analysis was used to phenotype B-cell populations in the bursa and spleen following IBDV infection. In the bursa, two IgM B-cell subpopulations, designated as A and B, were identified based on cell size and granularity. While both subpopulations differentially expressed IgM and Bu-1b surface markers, both groups displayed major histocompatibility complex class II surface antigens at equal levels. Following IBDV challenge of nonvaccinated birds, the B subpopulation was significantly reduced between 7 and 21 days postchallenge compared to either nonchallenged birds or vaccinated-challenged birds. However, the reduction of subpopulation B in the bursa, following IBDV exposure, did not reduce the levels of total serum IgA, IgG, and IgM, nor did it affect IgG and IgA B-cells in the spleen. Phenotypic analysis of the subpopulations identified differential expression of Lewis(x), IgM, Bu-1b, and MUI78 surface antigens between the subpopulations. Overall, these are the first studies to identify two distinct IgM B-cell subpopulations in the chicken bursa, and the first to describe the decrease in the IgM B-cell population relative to IgA and IgG B-cells following IBDV infection.

Screening for coeliac disease using anti‐tissue transglutaminase antibody assays, and prevalence of the disease in an Australian community

To determine (i) the prevalence of positive results of anti-tissue transglutaminase (anti-tTG) antibody assays and coeliac disease (CD) in a rural Australian community; and (ii) whether confirmatory testing of a positive assay result with an alternative anti-tTG assay improved the positive predictive value of the test in population screening for CD. Retrospective analysis in December 2004 of stored serum samples taken in 1994-1995 from 3011 subjects in the Busselton Health Study follow-up. Assays for IgA and IgG anti-tTG antibodies were performed, and positive or equivocal samples were retested with a different commercial anti-tTG assay. Available subjects with one or more positive assay results were interviewed, had serum collected for repeat anti-tTG assays and for HLA-DQ2 and HLA-DQ8 haplotyping and, if appropriate, gastroscopy and duodenal biopsy were performed. In unavailable subjects, HLA-DQ2 and -DQ8 haplotyping was performed on stored sera. Total serum IgA levels were assessed in subjects with initially negative assay results. Prevalence of anti-tTG positivity and biopsy-proven CD. In 47 of 3011 serum samples (1.56%), at least one anti-tTG assay gave positive results: 31 of the subjects who provided these sera were available for clinical review, and 21 were able to have a gastroscopy. Seventeen subjects (0.56%) were diagnosed with definite CD (14 were confirmed at gastroscopy, and three unavailable subjects had three positive results of anti-tTG assays and an HLA haplotype consistent with CD); in a further 12 unavailable subjects, CD status was considered equivocal, with one or more positive anti-tTG assay results and an HLA haplotype consistent with CD. If these subjects were regarded as having CD, the prevalence of CD would be 0.96%. The positive predictive value when all three anti-tTG assays gave positive results was 94%, but fell to 45.2% with only one positive result. The prevalence of anti-tTG antibodies in this population is 1.56%; the prevalence of CD is at least 0.56%. The utility of a single, positive result of an anti-tTG assay in screening for CD in the community is poor, and repeat and/or collateral assessment with different assays may decrease the need for gastroscopy and distal duodenal biopsy.