IS HUMAN UMBILICAL-CORD THE MOST SUITABLE SUBSTRATE FOR THE DETECTIONOF ENDOMYSIUM ANTIBODIES IN THE SCREENING AND FOLLOW-UP OF CELIAC-DISEASE

Background: Immunoglobulin A (IgA) anti-endomysium antibodies, the mos t reliable immunological marker for both the screening and follow-up o f coeliac disease, need monkey oesophagus as antigenic substrate; this limits their use because of high costs and the exploitation of endang ered species. Objectives: (1) To compare the diagnostic accuracy of an ti-endomysium antibodies detected by indirect immunofluorescence on mo nkey oesophagus and on human umbilical cord; (2) to evaluate their rel iability during follow-up in detecting noncompliant patients. Patients : One hundred and four untreated adults with biopsy-proven coeliac dis ease and 94 controls were investigated. Results: Endomysium antibodies were found in 99 patients (95%) on both substrates, with a specificit y, respectively, of 100% and 99% on monkey oesophagus and umbilical co rd. One year after gluten withdrawal, out of 47 patients who were inve stigated, only six presented with complete mucosal recovery: none of t hese subjects was positive on either substrates, while, among patients with persistent histological alterations, endomysium positivity persi sted in only 10 on monkey oesophagus, but in 32 on umbilical cord. His tology (recovery or persistent involvement) was in agreement with endo mysium (negative or positive) in 34% on monkey oesophagus, but in 81% on umbilical cord (P<0.0001). Conclusion: Human umbilical cord, with i ts comparable diagnostic efficiency, could replace monkey tissues, wit h the advantages of saving both money and monkeys. Moreover, it seems the most suitable substrate in the follow-up, as it enables detection of non-compliant patients with persisting mucosal alterations.