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

Am J Gastroenterol. 2011 Jul;106(7):1318-24. doi: 10.1038/ajg.2011.23. Epub 2011 Mar 1.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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%.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Bread
  • CD4-Positive T-Lymphocytes / immunology*
  • CD4-Positive T-Lymphocytes / metabolism
  • Celiac Disease / blood*
  • Celiac Disease / diagnosis*
  • Celiac Disease / immunology
  • Celiac Disease / pathology
  • Diagnostic Techniques, Digestive System
  • Endoscopy, Digestive System
  • Female
  • Flow Cytometry
  • Gastrointestinal Tract / immunology*
  • Glutens / immunology*
  • HLA-DQ Antigens / immunology*
  • HLA-DQ Antigens / metabolism
  • Humans
  • Male
  • Middle Aged
  • Young Adult

Substances

  • HLA-DQ Antigens
  • HLA-DQ2 antigen
  • Glutens