Key result
Measuring gut-homing CD8+ T cells after gluten challenge detects coeliac disease with ~97% sensitivity.
Why the study?
Diagnosing coeliac disease in individuals already on a gluten-free diet is challenging, and avoiding prolonged gluten challenge to induce intestinal damage requires effective immunological assays.
Does measuring activated gut-homing CD8+ T cells after a 3-day gluten challenge accurately diagnose coeliac disease in patients on a gluten-free diet?
Observational (n=70)
Single-blind (data analysis blinded to diagnostic result)
Yes
Does measuring activated gut-homing CD8+ T cells after a 3-day gluten challenge accurately diagnose coeliac disease in patients on a gluten-free diet?
Effect estimate: AUC 0.978 (95% CI 0.953-1.003)
Absolute Event Rate: 96.67% vs 95%
p-value: p=<10^-3
Measuring activated gut-homing CD8+ T cells after a 3-day gluten challenge offers a highly accurate and easily implementable blood test for diagnosing coeliac disease in patients already on a gluten-free diet.
May support blood-based coeliac diagnosis on gluten-free diets; leaves open prospective validation before practice change.
Background The diagnosis of coeliac disease (CD) in individuals that have started a gluten-free diet (GFD) without an adequate previous diagnostic work-out is a challenge. Several immunological assays such as IFN-γ ELISPOT have been developed to avoid the need of prolonged gluten challenge to induce the intestinal damage. We aimed to evaluate the diagnostic accuracy of activated gut-homing CD8+ and TCRγδ+ T cells in blood after a 3-day gluten challenge and to compare it with the performance of IFN-γ ELISPOT in a HLA-DQ2.5 subsample. Methods A total of 22 CD patients and 48 non-CD subjects, all of them following a GFD, underwent a 3-day 10-g gluten challenge. The percentage of two T cell subsets (CD8+ CD103+ β7hi CD38+/total CD8+ and TCRγδ+ CD103+ β7hi CD38+/total TCRγδ+) in fresh peripheral blood drawn baseline and 6 days after the challenge was determined by flow cytometry. IFN-γ ELISPOT assays were also performed in HLA-DQ2.5 participants. ROC curve analysis was used to assess the diagnostic performance of the CD8+ T cell response and IFN-γ ELISPOT. Results Significant differences between the percentage of the two studied subsets of CD8+ and TCRγδ+ cells at days 0 and 6 were found only when considering CD patients (p < 10−3 vs. non-CD subjects). Measuring activated CD8+ T cells provided accurate CD diagnosis with 95% specificity and 97% sensitivity, offering similar results than IFN-γ ELISPOT. Conclusions The results provide a highly accurate blood test for CD diagnosis in patients on a GFD of easy implementation in daily clinical practice.
No takes yet. Share an insight, caveat, or question.
Fernández‐Bañares et al. (2021) conducted an observational in Coeliac disease on a gluten-free diet (n=70). 3-day gluten challenge and flow cytometry for activated gut-homing CD8+ T cells vs. Non-coeliac subjects was evaluated on Diagnostic accuracy of activated gut-homing CD8+ T cells (CD8+ CD103+ β7hi CD38+/total CD8+) at day 6 (AUC 0.978, 95% CI 0.953-1.003, p=<10^-3). Measuring activated gut-homing CD8+ T cells in blood 6 days after a 3-day gluten challenge provided accurate coeliac disease diagnosis with 97% sensitivity and 95% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: