IMMUNOLOGY
Autoimmunity in focus: from coeliac disease to myositis/scleroderma
Alison Gall reports on proceedings of the biennial Autoimmune Focus meeting, which covered cutting-edge advances in clinical immunology and provided an opportunity for delegates to share experiences with colleagues.
The 2016 Autoimmune Focus meeting took place in May at the Hilton Metropole Hotel in Birmingham, and attracted over 120 delegates from across the UK and Ireland. The meeting was organised by Werfen and provided an opportunity for scientists working in the field of clinical immunology to come together, participate in seminars and discuss various current topics.
Coeliac disease The day began with two presentations on coeliac disease (CD). First, Professor Berne Ferry began with an update on the National Institute for Health and Care Excellence (NICE) guidelines and how they may impact on clinical laboratories. Current testing methods were summarised (IgA tissue transglutaminase and IgA endomysial antibodies) along with the importance of identifying IgA-deficient patients so that IgG- based tests for coeliac disease can be performed. Testing for human leucocyte antigen (HLA) DQ2 and HLA DQ8 was also mentioned; however it was advised that these should not be used routinely in diagnosis, but as an aid in cases which are difficult to classify. The pros and cons of serological tests for
coeliac disease were discussed, namely that serology can be extremely sensitive and specific and for this reason may remove the requirement for biopsy in diagnosis in the future. Currently, biopsy remains the ‘gold standard’; however, as lesions can be patchy within the intestine, serology is extremely useful and has the advantage of being non- invasive and less costly than biopsy. One
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current disadvantage of serological tests is that cut-off values and sensitivity/specificity vary depending on the manufacturer. Further work would therefore be necessary to standardise the assay between laboratories. Finally, disease monitoring using serology
was discussed. Evidence to date shows that antibody level does not always correlate with disease symptoms, histopathology, and compliance with a gluten-free diet. Therefore, although serology performs extremely well in the initial diagnosis of coeliac disease, it may be unsuitable for use as a monitor of disease activity and dietary compliance, as is suggested in the current NICE guidelines. It was proposed that this is a potential area requiring further investigation. Next, Dr Ronnie Chee delivered an
interesting talk on refractory coeliac disease (RCD), which is defined as over 12 months
persistence of symptoms while on a strict gluten-free diet. Refractory CD can occur at the time of diagnosis or as a secondary resistance years after the initial diagnosis. It is important to identify RCD patients as they are at risk of coeliac complications such as osteoporosis. He discussed the difficulty in determining if a patient does indeed have RCD, or if ongoing symptoms are due to poor diet compliance, albeit unknowingly, or other causes. He also discussed the fact that there is a slow responder group of CD patients (30– 40%) who may take between two and five years for their intestine to recover completely following the removal of gluten from the diet. Therefore, there are obvious difficulties in differentiating these patients from those who have true RCD. Dr Chee then went on to discuss the
classification of type 1 and type 2 RCD. To aid with this, intraepithelial lymphocyte (IEL) studies are performed by multicolour flow cytometry following isolation of lymphocytes from duodenal biopsies. Type 1 RCD is characterised by the presence of normal IELs and a polyclonal TcR rearrangement, whereas type 2 RCD has aberrant IEL and a clonal TcR rearrangement, which in some cases may lead to enteropathy-associated T-cell lymphoma (EATL), which is a highly
Delegates were able to view a range of scientific poster publications from UK-based study groups. AUGUST 2016 THE BIOMEDICAL SCIENTIST
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