PRODUCTION OF ANTIBODIES TO GLIADIN BY PERIPHERAL-BLOOD LYMPHOCYTES IN CHILDREN WITH CELIAC-DISEASE - THE USE OF AN ENZYME-LINKED IMMUNOSPOT TECHNIQUE FOR SCREENING AND FOLLOW-UP

Problems in the diagnosis of celiac disease are that a long time is ne eded between challenge with gluten and the appearance of the typical d iagnostic morphologic signs in gut mucosa. Furthermore, local immunity to gliadin is only slowly and often incompletely mirrored by serum Ig A anti-gliadin antibody (AGA) levels. It is known that a local IgA-ass ociated immune response in the gut may be better and more quickly mirr ored by an increase of circulating IgA-producing cells against the imm unogen than by IgA serum antibodies. We have therefore used an enzyme- linked immunospot (ELISPOT) assay to enumerate IgA AGA spot-forming ce lls (SFC) in peripheral blood in 82 children with suspected celiac dis ease or with other gastrointestinal symptoms. The numbers of IgA AGA S FC/10(6) mononuclear cells were markedly increased in 17 patients with untreated (and later biopsy-verified) celiac disease compared with he althy children, children with nonceliac disease, and patients treated for celiac disease (p < 0.0001). In 20 children with celiac disease th e numbers of IgA AGA SFC increased rapidly (p < 0.0001) after gluten c hallenge. As early as 2 wk after gluten challenge, 15/20 of these pati ents had abnormal levels of IgA AGA SFC, 6/20 patients had increased l evels of serum IgA AGA, and 7/20 had IgA anti-endomysium antibodies. O ur results indicate that analysis of IgA AGA production in peripheral blood cells may in further clinical studies provide a sensitive method for the diagnosis of celiac disease after a short time of gluten chal lenge.