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Celiac disease: from etiological factors to evolving diagnostic approaches

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Abstract

Celiac disease has advanced from a medical rarity to a highly prevalent disorder. Patients with the disease show varying degrees of chronic inflammation within the small intestine due to an aberrant immune response to the digestion of gliadin found in wheat. As a result, cytokines and antibodies are produced in celiac patients that can be used as specific biomarkers for developing diagnostic tests. This review paper describes celiac disease in terms of its etiological cause, pathological effects, current diagnostic tests based on mucosal biopsy, and the genetic basis for the disease. In addition, it discusses the use of gliadin-induced cytokines, antibodies and autoantibodies as a diagnostic tool for celiac disease. Despite good initial results in terms of sensitivity and specificity, when these immunological tests were used on a large scale, even in combination with genetic testing, the results showed lower predictive value. This review addresses that issue and ends with an outlook on future work required to develop diagnostic tests with greater accuracy in predicting celiac disease in the general public, thus avoiding the need for endoscopy and mucosal biopsy.

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Abbreviations

ELISA:

Enzyme-linked immunosorbent assay

NK:

Natural killer

HLA:

Human leukocyte antigen

TCR:

T-cell receptor

LMW:

Low molecular weight

CDR:

Complementarity-determining region

tTG:

Tissue transglutaminase

AGA:

Anti-gliadin antibodies

Anti-EMA:

Anti-endomysial antibodies

Anti-tTG:

Anti-transglutaminase antibodies

Anti-DGP:

Anti-deamidated gliadin peptide

IFA:

Indirect immunofluorescence

RIA:

Radioimmunoassay

GFD:

Gluten-free diet

SPR:

Surface plasmon resonance

DIG:

Diffusion in gel

IBD:

Inflammatory bowel disease

GIP:

Gluten immunogenic peptides

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Acknowledgements

The authors thank Dr. Jason Tye-Din, MBBS, PhD, FRACP, Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia, for his critical review and feedback on the manuscript. This research is supported by an Australian Government Research Training Program Scholarship. O.S. acknowledges the Australian Research Council and National Health and Medical Research Council for financial support (APP1101258, IH150100028).

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  1. Institute for Biomedical Materials and Devices (IBMD), The University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia

    Anantdeep Kaur & Olga Shimoni

  2. School of Life Sciences, The University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia

    Michael Wallach

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Correspondence to Olga Shimoni.

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Kaur, A., Shimoni, O. & Wallach, M. Celiac disease: from etiological factors to evolving diagnostic approaches. J Gastroenterol 52, 1001–1012 (2017). https://doi.org/10.1007/s00535-017-1357-7

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  • DOI: https://doi.org/10.1007/s00535-017-1357-7

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