Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 18, 2016; 8(26): 1105-1109
Published online Sep 18, 2016. doi: 10.4254/wjh.v8.i26.1105
Immune response to hepatitis B virus vaccine in celiac subjects at diagnosis
Martina Filippelli, Maria Teresa Garozzo, Antonino Capizzi, Massimo Spina, Sara Manti, Lucia Tardino, Carmelo Salpietro, Salvatore Leonardi
Martina Filippelli, Maria Teresa Garozzo, Antonino Capizzi, Massimo Spina, Lucia Tardino, Salvatore Leonardi, Department of Medical and Pediatric Sciences, University of Catania, 95100 Catania, Italy
Sara Manti, Carmelo Salpietro, Department of Pediatric Sciences, University of Messina, 98100 Messina, Italy
Author contributions: Filippelli M, Garozzo MT and Leonardi S revised the manuscript for final submission; Filippelli M, Capizzi A, Manti S, Tardino L and Salpietro C contributed to writing of the article; Garozzo MT analyzed the data; Spina M performed the research; Leonardi S designed the study; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University Hospital “Policlinico Vittorio Emanuele”.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Salvatore Leonardi, Professor, Department of Medical and Pediatric Sciences, University of Catania, Via S Sofia 78, 95100 Catania, Italy. leonardi@unict.it
Telephone: +39-9-53782764 Fax: +39-9-53782895
Received: May 20, 2016
Peer-review started: May 20, 2016
First decision: July 4, 2016
Revised: July 14, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 18, 2016
Processing time: 117 Days and 7.7 Hours
Abstract
AIM

To evaluate hepatitis B virus (HBV) vaccine response and correlation with human leukocyte antigens (HLA) and/or gluten intake in celiac patients at diagnosis.

METHODS

Fifty-one patients affected by celiac disease, diagnosed at the Department of Pediatrics of the University of Catania (Italy), were recruited. All patients were tested at admission for immunization against HBV, according to findings from analysis of quantitative HBV surface antibody (anti-HBs). The anti-HBs titer was measured by enzyme-linked immunosorbent assay. Following the international standards, subjects with antibody titer < 10 IU/L were defined as non-responders. The prevalence of responders and non-responders among celiac subjects and the distribution of immunization for age were examined. In addition, the prevalence of responders and non-responders was assessed for correlation to HLA and clinical features at diagnosis of celiac disease.

RESULTS

The entire study population was divided into three groups according to age: 24 patients aged between 0 to 5.5 years (48.9%, group A); 16 aged between 5.5 and 9.5 years (30.61%, group B); 9 aged between 9.5 and 17 years (18.75%, group C). Comparison of the percentage of responders and non-responders between the youngest and the oldest age group showed no significant difference between the two groups (P > 0.05). With regard to the HLA haplotype, comparison of the distribution of vaccination response showed no statistically significant difference between the different genotypes (homozygosity for the HLADQ2 haplotype compared with HLADQ2/DQ8 heterozygosity or other haplotypes; P > 0.05). Moreover, distribution of the responders according to clinical features of celiac disease showed no statistically significant differences (P > 0.05).

CONCLUSION

This prospective study confirmed the lower percentage of response to HBV vaccine in celiac subjects. However, the underlying mechanism remains unclear and further studies are needed.

Keywords: Celiac disease; Hepatitis B virus vaccination; Human leukocyte antigens; Gluten; Poor response

Core tip: Correlation between celiac disease and lower response to hepatitis B virus (HBV) vaccine has been demonstrated, but the causes remain unclear. The lack of prospective data represents an extensive gap between the time of vaccination and development of the immune response, contributing to select “false non-responders” (i.e., those who are destined to lose the antibody titer over time). The originality of our prospective study is that of analyzing the response to HBV vaccine in a group of celiac patients at the time of diagnosis in an attempt to nullify the percentage of error related to confounding factors.