Gluten, major histocompatibility complex, and the small intestine: A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’)

Background. Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence-outcome association have not been systematically assessed.Objectives. A quantitative review using meta-analysis of three decades of empirical research correlating adherence with ob

Patient Adherence and Medical Treatment Outcomes: A Meta-Analysis

Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in children and adolescents with gastrointestinal symptoms, dermatitis herpetiformis, dental enamel defects, osteoporosis, short stature, delayed puberty and persistent iron deficiency anemia and in asymptomatic individuals with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, selective immunoglobulin (Ig)A deficiency and first degree relatives of individuals with celiac disease. The Celiac Disease Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnosis and treatment of pediatric celiac disease based on an integration of a systematic review of the medical literature combined with expert opinion. The Committee examined the indications for testing, the value of serological tests, human leukocyte antigen (HLA) typing and histopathology and the treatment and monitoring of children with celiac disease. It is recommended that children and adolescents with symptoms of celiac disease or an increased risk for celiac disease have a blood test for antibody to tissue transglutaminase (TTG), that those with an elevated TTG be referred to a pediatric gastroenterologist for an intestinal biopsy and that those with the characteristics of celiac disease on intestinal histopathology be treated with a strict gluten-free diet. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the diagnosis and treatment of celiac disease in children and adolescents.

Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

American Gastroenterological Association (AGA) Institute Technical Review on the Diagnosis and Management of Celiac Disease

The STRO-1+ fraction of adult human bone marrow contains the osteogenic precursors

Osteocalcin is a small (Mr 5800), very interesting bone specific protein, synthesized by osteoblasts and measured in plasma as a biochemical indicator of bone formation. Many immunoassays for osteocalcin have been developed, including radio- and enzymoimmunoassays, with the use of monoclonal and polyclonal antibodies. These are used in many different clinical settings, including bone, kidney, and liver diseases. However, there is a wide range of published values for plasma osteocalcin concentrations in control and patient samples and this has hindered a more widespread adoption of osteocalcin measurement by clinicians.This review discusses how various immunoassays for osteocalcin may contribute to the wide variation of published values and suggests approaches for the development of standardized assays. For example, epitope specificity and immunoreactivity with multiple forms of osteocalcin and osteocalcin peptides in plasma are discussed. It also includes a recent update on interesting clinical ap...

Osteocalcin: diagnostic methods and clinical applications.

Purification and characterization of aspartate aminotransferases from soybean root nodules and rhizobium japonicum

Peroral duodenojejunal biopsies were performed on 114 of 195 first degree relatives of 31 index coeliac patients in 28 families. Twelve of these biopsies were characteristic of coeliac disease. Birth order did not influence the incidence of coeliac disease. The mode of inheritance is not typical of simple Mendelian inheritance but is compatible with a polygenic inheritance with a very high heritability or a dominant inheritance with a very low rate of expression in heterozygotes.

The enzyme levels and electron microscopic appearances of the histologically normal mucosa of coeliac relatives was not different from that of a control group.

Family Studies in Coeliac Disease

Subcellular localization of enzymes involved in the assimilation of Ammonia by soybean root nodules

We have developed a rapid enzyme immunoassay for progesterone in saliva. This solid-phase assay is carried out on microtitre plates with no extraction or centrifugation steps. The detection limit of the assay is 200 fg per well (3.2 pmol/L). Intra- and interassay coefficients of variation for low, medium, and high concentrations of progesterone were 7.5, 16.0; 9.1, 8.3; and 8.7, 6.7%, respectively. Correlation between total plasma progesterone (assayed by enzyme immunoassay with extraction) and salivary progesterone concentrations was good (r = 0.848, p less than 0.001, n = 56). We found the assay useful for monitoring ovarian function. The analytical procedure is convenient, and one person can assay more than 200 saliva samples per working day. The turnaround time for 36 samples is 2 h, including 1.5 h of incubation time, when previously coated plates are used. We conclude that such assays are very suitable for measuring progesterone in serial saliva samples and could become the preferred method for monitoring ovarian function.

Patrick F. Fottrell

Papers

Osteocalcin: diagnostic methods and clinical applications.

Purification and characterization of aspartate aminotransferases from soybean root nodules and rhizobium japonicum

Family Studies in Coeliac Disease

Subcellular localization of enzymes involved in the assimilation of Ammonia by soybean root nodules

Direct solid-phase enzyme immunoassay of progesterone in saliva.