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- Title
γδ+ T-Cells Is a Useful Biomarker for the Differential Diagnosis between Celiac Disease and Non-Celiac Gluten Sensitivity in Patients under Gluten Free Diet.
- Authors
Martín-Cardona, Albert; Carrasco, Anna; Arau, Beatriz; Vidal, Judith; Tristán, Eva; Ferrer, Carme; Gonzalez-Puglia, Gerardo; Pallarès, Natàlia; Tebé, Cristian; Farrais, Sergio; Núñez, Concepción; Fernández-Bañares, Fernando; Esteve, Maria
- Abstract
Background: The differential diagnosis between patients with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) is difficult when a gluten-free diet (GFD) has been initiated before the diagnostic work-up. Isolated increases in TCRγδ+ and celiac lymphogram (increased TCRγδ+ plus decreased CD3−) may enable differential diagnosis in this challenging clinical setting. This study evaluated: (1) the accuracy of %TCRγδ+ and celiac lymphogram for diagnosing CD before and after GFD and for differentiation with NCGS; (2) TCRγδ+ kinetics at baseline and after starting GFD in both CD and NCGS. Methods: The inclusion criteria were patients with CD (n = 104), NCGS (n = 37), and healthy volunteers (n = 18). An intestinal biopsy for intraepithelial lymphogram by flow cytometry was performed at baseline and after GFD. The optimal cutoff for CD diagnostic accuracy was established by maximizing the Youden index and via logistic regression. Results: %TCRγδ+ showed better diagnostic accuracy than celiac lymphogram for identifying CD before and after GFD initiation. With a cutoff > 13.31, the accuracy for diagnosing CD in patients under GFD was 0.88 [0.80–0.93], whereas the accuracy for diagnosing NCGS (%TCRγδ+ ≤ 13.31) was 0.84 [0.76–0.89]. The percentage of TCRγδ+ cells showed differential kinetics between CD (baseline 22.7% [IQR, 16.4–33.6] vs. after GFD 26.4% [IQR, 17.8–36.8]; p = 0.026) and NCGS (baseline 9.4% [IQR, 4.1–14.6] vs. after GFD 6.4% [IQR, 3.2–11]; p = 0.022). Conclusion: TCRγδ+ T cell assessment accurately diagnoses CD before and after a GFD. Increased TCRγδ+ was maintained in the long term after GFD in CD but not in NCGS. Altogether, this suggests the potential usefulness of this marker for the differential diagnosis of these two entities in patients on a GFD.
- Subjects
SPAIN; CELIAC disease diagnosis; FLOW cytometry; DIFFERENTIAL diagnosis; T cells; DATA analysis; RESEARCH funding; LOGISTIC regression analysis; DESCRIPTIVE statistics; GLUTEN-free diet; STATISTICS; CELIAC disease; CELL receptors; BIOMARKERS; SENSITIVITY &; specificity (Statistics)
- Publication
Nutrients, 2024, Vol 16, Issue 14, p2294
- ISSN
2072-6643
- Publication type
Article
- DOI
10.3390/nu16142294