Key result
Parechovirus infections in early childhood were significantly more frequent in genetically at-risk children who later developed celiac disease compared to matched controls (aOR 1.67).
Why the study?
To test whether parechovirus and anellovirus infections were associated with subsequent celiac disease in children before transglutaminase 2 antibody development.
Does parechovirus infection increase the risk of celiac disease in genetically at-risk children?
Case-Control (n=74)
Yes
Does parechovirus infection increase the risk of celiac disease in genetically at-risk children?
Odds Ratio: 1.67 (95% CI 1.14–2.45)
Absolute Event Rate: 16.1% vs 11.1%
p-value: p=0.01
Early-life parechovirus infections are associated with the development of celiac disease in genetically at-risk children, suggesting a potential viral trigger for the disease.
Supports parechovirus as potential celiac trigger in at-risk children; hypothesis-generating and requires prospective confirmation before practice implications.
INTRODUCTION: To test whether parechovirus and anellovirus, frequent enteric viruses, were associated with subsequent celiac disease (CD). We hypothesized that children who later developed CD would have increased frequency of parechovirus infections before transglutaminase 2 (TG2) antibody development. Anellovirus testing was exploratory, as a potential marker of immune status. METHODS: Matched case-control design nested within a longitudinal birth cohort (the MIDIA study) of children at genetic risk of CD (carrying the human leukocyte antigen genotype DR4-DQ8/DR3-DQ2, recruited throughout Norway during 2001-2007). We retrospectively tested blood samples taken at age 3, 6, 9, and 12 months, and then annually, to determine when TG2 antibodies developed. Of 220 genetically at-risk children tested, 25 were diagnosed with CD (cases; ESPGHAN 2012 criteria) and matched for follow-up time, birthdate, and county of residence with 2 randomly selected children free from CD (controls) from the cohort. Viruses were quantified in monthly stool samples (collected from 3 through 35 months of age) using real-time polymerase chain reaction methods. RESULTS: Parechovirus was detected in 222 of 2,005 stool samples (11.1%) and was more frequent in samples from cases before developing TG2 antibodies (adjusted odds ratio 1.67, 95% confidence interval 1.14-2.45, P = 0.01). The odds ratio was higher when a sample was positive for both parechovirus and enterovirus (adjusted odds ratio 4.73, 95% confidence interval 1.26-17.67, P = 0.02). Anellovirus was detected in 1,540 of 1,829 samples (84.2%), but did not differ significantly between case and control subjects. DISCUSSION: Early-life parechovirus infections were associated with development of CD in genetically at-risk children.
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Tapia et al. (2020) conducted a case-control in Celiac disease (n=74). Parechovirus infection vs. Matched controls without celiac disease was evaluated on Parechovirus positivity in stool samples before transglutaminase 2 antibody development (aOR 1.67, 95% CI 1.14-2.45, p=0.01). Parechovirus infections in early childhood were significantly more frequent in genetically at-risk children who later developed celiac disease compared to matched controls (aOR 1.67).
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