Protein-Losing Enteropathies

Strober, Warren; Fuss, Ivan J.

doi:10.1016/b978-0-12-415847-4.00086-0

Cited by 4 publications

(3 citation statements)

References 192 publications

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“…Published evidence showing an immune‐mediated etiology of IL in dogs (and people) is totally lacking . The obvious place to seek an anomaly is in the lymphatic endothelium or in the fine collagen fibers that anchor lymphatic capillaries to surrounding connective tissue, but none has ever been described.…”

Section: Lymphatic Structure and Functionmentioning

confidence: 99%

“…A pathogenic role of the intestinal microbiome is not recognized in PLE; however, intestinal dysbiosis with a Gram‐negative shift is emerging as a contributor to IBD pathophysiology. It should not be forgotten that the loss of immune system components in people with PLE depletes immune barrier function, and so potentially, intestinal dysbiosis could be of greater severity and detriment in IBD‐PLE . Disrupted mucosal immunity and dysbiosis in PLE are further implied by the observation that mucosal neutrophils were significantly more often present ( P = .003) in dogs with chronic enteropathy (CE) and hypoalbuminemia (17/37, 46%) than CE‐normoalbuminemia (7/46, 15%) .…”

Section: Special Testsmentioning

confidence: 99%

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Comparative pathophysiology and management of protein‐losing enteropathy

Craven

Washabau

2019

Veterinary Internal Medicne

116

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Protein‐losing enteropathy, or PLE, is not a disease but a syndrome that develops in numerous disease states of differing etiologies and often involving the lymphatic system, such as lymphangiectasia and lymphangitis in dogs. The pathophysiology of lymphatic disease is incompletely understood, and the disease is challenging to manage. Understanding of PLE mechanisms requires knowledge of lymphatic system structure and function, which are reviewed here. The mechanisms of enteric protein loss in PLE are identical in dogs and people, irrespective of the underlying cause. In people, PLE is usually associated with primary intestinal lymphangiectasia, suspected to arise from genetic susceptibility, or “idiopathic” lymphatic vascular obstruction. In dogs, PLE is most often a feature of inflammatory bowel disease (IBD), and less frequently intestinal lymphangiectasia, although it is not proven which process is the true driving defect. In cats, PLE is relatively rare. Review of the veterinary literature (1977‐2018) reveals that PLE was life‐ending in 54.2% of dogs compared to published disease‐associated deaths in IBD of <20%, implying that PLE is not merely a continuum of IBD spectrum pathophysiology. In people, diet is the cornerstone of management, whereas dogs are often treated with immunosuppression for causes of PLE including lymphangiectasia, lymphangitis, and crypt disease. Currently, however, there is no scientific, extrapolated, or evidence‐based support for an autoimmune or immune‐mediated mechanism. Moreover, people with PLE have disease‐associated loss of immune function, including lymphopenia, severe CD4+ T‐cell depletion, and negative vaccinal titers. Comparison of PLE in people and dogs is undertaken here, and theories in treatment of PLE are presented.

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Section: Lymphatic Structure and Functionmentioning

confidence: 99%

Section: Special Testsmentioning

confidence: 99%

Comparative pathophysiology and management of protein‐losing enteropathy

Craven

Washabau

2019

Veterinary Internal Medicne

116

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“…Serologic test methods have gained high priority in screening for, in diagnostic work-up for, and in followup of celiac disease (1,2). Gliadin antibodies (3), endomysium antibodies (EMA) (4), and, recently, tissue transglutaminase (tTG) antibodies (5) have been used successfully in this context.…”

mentioning

confidence: 99%

Comparative Evaluation of Serologic Tests for Celiac Disease: A European Initiative Toward Standardization

Stern

2000

J. pediatr. gastroenterol. nutr.

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BackgroundSerologic methods have been used widely to test for celiac disease and have gained importance in diagnostic definition and in new epidemiologic findings. However, there is no standardization, and there are no reference protocols and materials.MethodsThe European working group on Serological Screening for Celiac Disease has defined robust noncommercial test protocols for immunoglobulin (Ig)G and IgA gliadin antibodies and for IgA autoantibodies against endomysium and tissue transglutaminase. Standard curves were linear in the decisive range, and intra‐assay variation coefficients were less than 5% to 10%. Calibration was performed with a group reference serum. Joint cutoff limits were used. Seven laboratories took part in the final collaborative study on 252 randomized sera classified by histology (103 pediatric and adult patients with active celiac disease, 89 disease control subjects, and 60 blood donors).ResultsIgA autoantibodies against endomysium and tissue transglutaminase rendered superior sensitivity (90% and 93%, respectively) and specificity (99% and 95%, respectively) over IgA and IgG gliadin antibodies. Tissue transglutaminase antibody testing showed superior receiver operating characteristic performance compared with gliadin antibodies. The κ values for interlaboratory reproducibility showed superiority for IgA endomysium (0.93) in comparison with tissue transglutaminase antibodies (0.83) and gliadin antibodies (0.82 for IgG, 0.62 for IgA).ConclusionsBasic criteria of standardization and quality assessment must be fulfilled by any given test protocol proposed for serologic investigation of celiac disease. The working group has produced robust test protocols and reference materials available for standardization to further improve reliability of serologic testing for celiac disease.

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Protein-Losing Enteropathy

Ozen,

Lenardo

2023

N Engl J Med

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Protein-Losing Enteropathies

Cited by 4 publications

References 192 publications

Comparative pathophysiology and management of protein‐losing enteropathy

Comparative pathophysiology and management of protein‐losing enteropathy

Comparative Evaluation of Serologic Tests for Celiac Disease: A European Initiative Toward Standardization

Protein-Losing Enteropathy

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