IMPACT OF A SARS-COV-2 INFECTION IN PATIENTS WITH CELIAC DISEASE

  1. Luca Elli
  2. Federica Facciotti
  3. Vincenza Lombardo
  4. Alice Scricciolo
  5. David S Sanders
  6. Valentina Vaira
  7. Donatella Barisani
  8. Maurizio Vecchi
  9. Andrea Costantino
  10. Lucia Scaramella
  11. Bernardo Dell'Osso
  12. Luisa Doneda
  13. Leda Roncoroni

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Abstract

Objective. The SARS-CoV-2 pandemic has spread across the world causing a dramatic number of infections and deaths. No data are available about the effects of an infection in patients affected by celiac disease (CD) in terms of the development of related symptoms and antibodies. We aimed to investigate the impact of the SARS-CoV-2 pandemic in celiac patients. Design. During a lockdown, the celiac patients living in the Milan area were contacted and interviewed about the development of COVID-19 symptoms as well as adherence to an anti-virus lifestyle and a gluten-free diet (GFD). They were also given a stress questionnaire to fill in. The development of anti-SARS-CoV-2 IgG and IgA (anti-RBD and N proteins) and the expression of the duodenal ACE2 receptor were investigated. When available, duodenal histology, anti-tissue transglutaminase IgA (tTGA), presence of immunologic comorbidities and adherence to the GFD were analysed as possible risk factors. Results. 362 celiac patients have been interviewed and 42 (11%) presented with COVID-19 symptoms. The presence of symptoms was not influenced by tTGA positivity, presence of duodenal atrophy or adherence to GFD. 37% of the symptomatic patients presented anti-SARS-CoV-2 immunoglobulins (Ig). Globally, 18% of celiac patients showed anti-SARS-CoV-2 Ig vs 25% of the non-celiac control (p=0.18). The values of anti-RBD IgG/IgA and anti-N IgG did not differ from the non-celiac controls. Celiac patients had a significant lower level of anti-N IgA. The ACE2 receptor was detected in the non-atrophic duodenal mucosa of celiac patients; atrophy was associated with a lower expression of the ACE2 receptor. Conclusion. CD patients have an anti-SARS-CoV-2 Ig positiveness and profile similar to non-celiac controls, except for anti-N IgA. The main celiac parameters and adherence to the GFD do not influence the development of a different Ig profile.

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  1. ScreenIT

    SciScore for 10.1101/2020.12.15.20248039: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Adult patients underwent a medically-assisted phone interview after they had given their oral informed consent.
    IRB: This study was approved by the local Ethical Committee (reference number 458_2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Detection of anti-SARS-CoV-2 antibodies by ELISA: The ELISA assay to detect immunoglobulins (Ig) G and A uses a fragment of the SARS-CoV-2 Spike glycoprotein (S-protein) and the Nucleocapsid (N protein) as antigens based on the recently published protocol [17–19].
    anti-SARS-CoV-2
    suggested: None
    a fragment of the SARS-CoV-2 Spike glycoprotein
    suggested: None
    Briefly, after binding the proteins (RBD and N proteins) to a Nunc Maxisorp ELISA plate, and blocking aspecific bindings with PBS-BSA 3%, patients’ sera to be analysed were applied to the plate to allow antibody binding at a final dilution of 1:200, revealed with secondary anti-human-IgG (BD, clone G18-145) and IgA (Biolegend, Poly24110) antibody conjugated to HRP.
    anti-human-IgG (BD
    suggested: None
    IgA
    suggested: (BioLegend Cat# 411002, RRID:AB_2686938)
    Poly24110
    suggested: (BioLegend Cat# 411002, RRID:AB_2686938)
    Experimental Models: Cell Lines
    SentencesResources
    The RBD proteins have been produced in mammalian HEK293F cells as glycosylated proteins by transient transfection with pCAGGS vectors generated in Prof.
    HEK293F
    suggested: RRID:CVCL_6642)
    Software and Algorithms
    SentencesResources
    A 5% Significance level was used, and the software packages STATA® v. 13.1 (StataCorp LLC, College Station, TX, USA) and GraphPad Prism v. 6 (GraphPad Software, La Jolla, CA, USA) were used for analysis and graph processing.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.12.15.20248039v1 on medRxiv