Immune reaction against the cytoskeleton in coeliac disease

Background-The cytoskeleton actin network of intestinal microvilli has been found to be rapidly impaired after gluten challenge in coeliac disease (CD ). The aim of this study was to investigate the presence of an immune react ion towards cytoskeleton structures such as actin filaments in CD. Methods-Eighty three antiendomysial antibody positive CD patients (52 child ren and 31 adults) were studied at our outpatient clinics from 1996 to 1998 using indirect immunofluorescence, ELISA, and western blotting for antiact in (AAA) and antitissue transglutaminase (TGA) antibodies before and after a gluten free diet (GFD). Sixteen patients with smooth muscle antibody posi tive autoimmune hepatitis, 21 with inflammatory bowel diseases, seven with small bowel bacterial overgrowth, and 60 healthy subjects were studied as c ontrols. Results-Fifty nine of 83 CD patients (28/31 adults (90.3%); 31/52 children (59.6%)) were positive for IgA and/or IgG AAA. Seventy seven (92.7%) were p ositive for IgA TGA. IgA AAA were strongly correlated with more severe degr ees of intestinal villous atrophy (p<0.0001; relative risk 86.17). After a GFD, AAA became undetectable within five months. Conclusions-Apart from the immune reaction against the extracellular matrix , we have described an immune reaction against the cytoskeleton in both chi ldren and adults with CD. As AAA are strongly associated with more severe d egrees of villous atrophy, they may represent a useful serological marker o f severe intestinal atrophy in CD.