clinical and immunological relevance of anti-neuronal antibodies in celiac disease with neurological manifestations

abstract aim: to assess anti-neuronal antibodies (na) prevalence and their correlation with neurological disorders and bowel habits in celiac disease (cd) patients. background: neurological manifestations are estimated to occur in about 10% of celiac disease patients and na to central nervous system (cns) and enteric nervous system (ens) are found in a significant proportion of them. little is known about the clinical and immunological features in cd patients with neurological manifestations. patients and methods : na to cns and ens were investigated in 106 cd patients and in 60 controls with autoimmune disorders by indirect immunofluorescence on rat / primate cerebellar cortex and intestinal (small and large bowel) sections. results : igg na to cns (titer 1:50 - 1:400) were positive in 23 celiacs (21%), being more frequently detected in those with neurological disorders that in those without neurological dysfunction (49% vs. 8%, p< 0.0001). of the 26 celiacs (24%) with igg na to ens, 11 out of 12 with an antibody titer > 1:200 had severe constipation. only one patient with cerebellar ataxia and intestinal sub-occlusion was positive for na to cns and ens. na to cns and ens were found in 7% and 5% of controls, respectively. conclusions : in cd the positivity of na to cns can be regarded as a marker of neurological manifestations. high titer na to ens are associated with severe constipation. the demonstration of na to cns and ens suggests an immune-mediated pathogenesis leading to central neural impairment as well as gut dysfunction (hence constipation), respectively.