Raleigh K. Austin

Evidence for the role of a human intestinal adenovirus in the pathogenesis of coeliac disease.

We previously noted a region of amino acid sequence homology between A-gliadin, a major alpha-gliadin component known to activate coeliac disease, and the early region E1b protein of human adenovirus serotype 12 (Ad12), an adenovirus isolated from the human intestinal tract. In the present study sera from coeliac disease patients from the United Kingdom and the United States were assayed for neutralising antibody to Ad12 as evidence of past exposure to that virus and for antibody to synthetic peptides of A-gliadin from the region of shared sequence with the Ad12 E1b protein. Eighty nine per cent of untreated coeliac disease patients had evidence of previous Ad12 infection. There was also a significant increase in the prevalence of neutralising antibody to Ad12 among treated adults (33.3%) and children (30.8%) with coeliac disease compared with controls (0-12.8%) in the western USA and in London. There was no evidence for an increased prevalence of infection with a closely related adenovirus, adenovirus 18, or another enteric virus, Echovirus 11, among coeliac disease subjects. Additional studies documented that a region of A-gliadin that shares amino acid sequence homology with the adenovirus 12 E1b protein could be recognised as an antigenic determinant in active coeliac disease patients. Taken together, these data are compatible with the hypothesis that a viral protein may play a role in the pathogenesis of coeliac disease, perhaps by virtue of immunological cross reactivity between antigenic determinants shared by the viral protein and alpha-gliadins.

Gluten-sensitive enteropathy. Immunoglobulin G heavy-chain (Gm) allotypes and the immune response to wheat gliadin.

Anti-gliadin antibody was measured by radioimmunoassay in 30 Caucasians with gluten-sensitive enteropathy (GSE). 22 GSE patients maintained on a gluten-free diet for 1.5 to 20 yr (mean duration 76 mo) had elevated serum concentrations of IgG antigliadin antibody. Among GSE patients on a gluten-free diet, antigliadin antibody was seen only in those having the chromosome 14-encoded IgG immunoglobulin heavy chain allotype marker G2m(n). IgG antigliadin antibody was found in GSE patients with G2m(n) regardless of whether the HLA-B8 and/or -DR3 major histocompatibility complex antigens that occur frequently in GSE were present. No patient lacking G2m(n) had significant levels of antigliadin antibody. The association between antigliadin antibody and the immunoglobulin heavy chain allotype marker G2m(n) in GSE patients likely reflects the presence of Gmn-linked variable region genes or Gmn-linked genes that regulate variable region gene expression.

Sensitive radioimmunoassay for the broad-spectrum antiviral agent ribavirin.

Ribavirin, 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxyamide (Virazole; Viratek, Inc., Covina, Calif.), has a broad spectrum of antiviral activity. However, the study of the absorption, metabolism, and excretion of this compound has been limited by the lack of an appropriate assay for ribavirin and its metabolites. Since ribavirin has definite potential for therapeutic use, we developed a radioimmunoassay to measure ribavirin levels in clinical specimens. To prepare an effective immunogen, ribavirin was monosuccinylated and coupled to ovalbumin. The competitive binding radioimmunoassay, in which tritium-labeled ribavirin and rabbit antiribavirin serum were used, was quantitative for ribavirin at concentrations of 1 pmol/100 microliter in urine or plasma samples. The rabbit antibody cross-reacted with the major metabolite of ribavirin, 1,2,4-triazole-3-carboxamide, at a low level (2 to 5%) which did not interfere with ribavirin binding until concentrations of 1,2,4-triazole-3-carboxamide 10- to 100-fold higher than ribavirin were present in mock samples, a condition not present in biological specimens. We used the ribavirin radioimmunoassay to determine the ribavirin concentration in mouse plasma after intraperitoneal administration, in the sera of adults from Sierra Leone after oral or intravenous administration for treatment of suspected Lassa fever, and in the sera of children in the United States after small-particle aerosol administration. Our experience with the radioimmunoassay indicates that it is sensitive, accurate, and reproducible. The assay will permit studies leading to a better understanding of the pharmacology and pharmacokinetics of this potentially useful antiviral drug.

Specificity of antigliadin antibody in celiac disease

Celiac disease is activated in genetically susceptible individuals by the dietary ingestion of wheat gluten and similar proteins in other grains. Gliadins are a complex mixture of proteins that contain at least 40 different components in a single variety of wheat. We have purified the four major electrophoretic fractions of wheat gliadin and examined the specificity of antigliadin antibody for those fractions by radioimmunoassay in 30 patients with celiac disease and 30 matched controls. All patients had been on a gluten-free diet for more than 18 mo and were clinically asymptomatic at the time of study. Seventeen of 30 patients had increased antibody levels to one or more of the gliadin fractions. Twelve of 17 patients had elevated antibody to A or 6D alpha-gliadin, 9 of 17 to beta-gliadin, 10 of 17 to gamma-gliadin, and 8 of 17 to omega-gliadin. Of the 17 subjects, 5 had increased antigliadin antibody levels to one gliadin fraction only, whereas 12 had increased levels to two or more fractions. Of the 17 patients with increased antibody titers, 16 had the G2m(n) immunoglobulin heavy chain allotype marker and 14 had the serologic HLA specificities-B8 or-DR3, or both. Definition of the wheat gliadin fractions and specific gliadin peptides that can activate celiac disease remains an open question. These data indicate that antigliadin antibody in the serum of asymptomatic patients with celiac disease who are maintained on a gluten-free diet can be directed against one or a multiple of gliadin fractions.