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Organ culture and its diagnostic use in celiac disease

TO THE EDITOR: We read with great interest the article by Vogelsanget al., recently published in the American Journal of Gastroenterology , concerningin vitro production of antiendomysial antibodies (EMA) after culture of intestinal tissue from patients with celiac disease (CD) (1). In agreement with our previous studies, data emerging from the work of Vogelsanget al. demonstrated that EMA are produced by the intestinal mucosa and, indeed, are detectable in their culture supernatants (2, 3). In vitro culture of intestinal mucosa, because of the simplicity of use and the high sensitivity and specificity of antiendomysial antibodies in celiac disease, is today a useful tool in the diagnosis of new CD patients. Nevertheless, the aforementioned studies showed different data on in vitro gliadin challenge of the intestinal mucosa from CD patients on a gluten-free diet (GFD). Vogelsanget al. detected EMA in 11.1% of the organ cultures of CD patients on a GFD after stimulus with gliadin for 24 h,versusthe 73.9% found in our study in the same experimental conditions. Antiendomysial antibodies, detected by means of an indirect immunofluorescence technique (i-IFL), are strictly observer-dependent. Our data show that thein vitro EMA production does not depend on the gliadin concentration used for the challenge or on the time of the GFD, but rather on the culture time, which is important for their detectability. In our previous investigation we reported that cultures from three patients on GFD, who were challenged for 48 h with gliadin, were more strongly positive for EMA than at 24 h (2). We have extended this observation, and our data (as yet unpublished) confirm a higher sensitivity of mucosal culture at 48 h than that at 24 h. Our study offers the possibility of using organ culture to perform in vitro gliadin challenge, but it is mandatory to prolong the culture time to 48 h.