Serum antigliadin antibodies in cerebellar ataxias: a systematic review and meta-analysis

Abstract

Background Gluten sensitivity refers to prominent immunological responses to gluten, usually in conjunction with elevated levels of serum antigliadin antibody (AGA). The association between AGA and cerebellar ataxias has been inconsistently reported. Methods We performed a systematic literature search and a meta-analysis to study the weighted pooled OR of idiopathic cerebellar ataxia (IDCA) cases to controls or to hereditary ataxia (HA) for AGA seropositivity using fixed effect model. Results Eleven studies were included, with a total of 847 IDCA cases, 1654 controls and 445 HA cases. IDCA cases had fourfold higher odds than controls (OR 4.28, 95% CI 3.10 to 5.90) and twofold higher odds than HA cases (OR 2.23, 95% CI 1.45 to 3.44) of having AGA seropositivity. Sensitivity analysis excluding the most weighted study, which accounted for 69% of the total weight, still showed similar associations (IDCA vs controls, OR 3.18, 95% CI 1.79 to 5.67 and IDCA vs HA, OR 1.72, 95% CI 1.03 to 2.86, respectively). The subgroup analysis showed that, when compared with controls, IDCA cases of both East Asian and Western countries had approximately threefold to fourfold higher odds to have AGA seropositivity (OR 3.41, 95% CI 1.67 to 6.97 and OR 4.53, 95% CI 3.16 to 6.49, respectively), suggesting the lack of ethnic heterogeneity. The odds of AGA seropositivity for HA cases was not significantly higher than controls (OR 1.41, 95% CI 0.82 to 2.44). Conclusion Our study indicates the association between AGA and IDCA, across different geographic regions.

Autoantibodies in the Extraintestinal Manifestations of Celiac Disease

“…Among these, idiopathic or sporadic ataxia associated with anti-gliadin antibodies has been the best studied in terms of understanding its frequency in different populations of ataxia patients and its potential etiology and pathogenic mechanism. A recent meta-analysis of several studies further validates the presence of significantly increased levels of antibody to gliadin among patients with non-hereditary ataxia [ 74 ]. There have been suggestions that gluten ataxia would fit better within the spectrum of non-celiac wheat/gluten sensitivity (NCWS) rather than celiac disease, based on serologic, histologic, and genetic markers [ 75 , 76 ].…”

Diagnosis and management of progressive ataxia in adults

“…Autoimmunity is increasingly recognised as a cause of progressive cerebellar ataxia. A cohort of patients from Sheffield with ataxia and positive antigliadin antibodies (a serological marker of gluten sensitivity and coeliac disease) is perhaps the best studied 13. In this series, 25% of all sporadic cases were diagnosed with gluten ataxia, although in other centres the proportion recognised is considerably lower 11.…”

Ataxia

“…Serum anti-gliadin antibodies and tissue transglutaminase antibodies are associated with ataxia with gluten sensitivity. 7 Anti-thyroperoxidase antibody can indicate ataxia associated with steroid-responsive encephalopathy. Paraneoplastic antibodies should also be examined when encountering patients with subacute cerebellar ataxia.…”