Correlation Between Non-Invasive Biomarkers and Histological Healing in Children with Celiac Disease: Role of Cytokines, Intestinal Fatty Acid–Binding Protein, and Tissue Transglutaminase Antibodies

Purpose: Data on treatment response in children with celiac disease (CeD), particularly with respect to changes in tissue transglutaminase IgA antibodies (tTGA-IgA), cytokines, intestinal fatty acid-binding protein (I-FABP), and quantitative histology, remain limited.To evaluate the utility of non-invasive parameters (NIPs), including I-FABP, tTGA-IgA, and cytokines, as potential markers of mucosal recovery in pediatric CeD.Methods: This single-center, prospective, observational follow-up study included children with newly diagnosed CeD.Blood and duodenal biopsy samples were obtained at baseline and after 1 year of follow-up.Results: Seventy-nine children who underwent follow-up biopsy at 1 year were analyzed.Significant improvements were observed in anthropometric measures, histological parameters, tTGA-IgA levels, cytokine profiles (tumor necrosis factor-alpha [TNF-], interferon-gamma [IFN-], interleukin [IL]-15, IL-6, and IL-10), and I-FABP levels.tTGA-IgA showed strong correlations with histological indices, including intraepithelial lymphocyte (IEL) count (r=0.554,p<0.001), villous height (r=-0.557,p<0.001), crypt depth (r=0.553,p<0.001), and villous-to-crypt ratio (VCR; r=-0.561,p<0.001).TNF- demonstrated weak correlation with crypt depth (r=0.24,p=0.04) and VCR (r=-0.22,p=0.05).IL-15 levels (r=0.34,p=0.003) and cycle threshold (Ct) scores correlated with IEL counts (r=-0.22,p=0.048).IFN- Ct scores also correlated with IEL counts (r=-0.34,p=0.001).Conclusion: Among the NIPs evaluated, tTGA-IgA showed the strongest correlation with mucosal recovery at 1 year.TNF-, IL-15, and IFN- demonstrated weaker but significant correlations and may have the potential as adjunctive NIP of mucosal healing in pediatric CeD.