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From:
A Gilliland <[log in to unmask]>
Date:
Thu, 30 Aug 2001 06:22:19 -0700
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<<Disclaimer: Verify this information before applying it to your situation.>>

Hi All--

Thanks to everyone who responded. Approximately half
of the replies were to request a summary and the other
half recommended Dr. Fine's lab, found at:
www.enterolab.com.

I did a little further checking with a medical type
friend of mine in New Zealand re: DNA testing and
possible reliable testing labs in the U.S. or
overseas. This is what she wrote:

______________________

(I don't know whether you know much about HLA
molecules - these are things in cells that hold
antigens on the cell surface, in readiness for being
checked out by T-cells.  If one of the antigens is
recognized by a T-cell and is given the necessary
signals by the antigen-bearing cell, the T-cell
multiplies and mounts an attack against that antigen
everywhere it can be found.  Each person inherits
eight different genes for HLA molecules from each
parent, so we have a potential of 16 different kinds
of HLA molecules,assuming no duplications from the two
parents.  Each of these molecules is different in the
shape of the little groove in which it holds an
antigen.

The shape of that groove and the presence and location
of charged amino acids in the groove determine what
antigens can be held on the HLA molecule. Think of a
set of platters with different shapes - each shape
makes it possible for that platter to securely hold a
particular shape of delicacy.

Because of occasional mutation in the genes for HLA
molecules, so there is a wide variety of specific
genes for each of the 16 HLA molecules.  These
genes get handed down from parent to child, so often
are specific to a particular population or race.

It has been observed that some diseases have a strong
association with a specific version of one of these
"platters".  People who do not have a
platter of this shape are unable to present the same
exact antigens to T-cells, so don't mount an immune
attack against that antigen.

However, no one version of one of the HLA genes has
been found in all the cases studied.  Also, not
everyone with a verson associated with celiac
disease actually develops the disease.  There is a
specific adenovirus that is also linked to some cases
of adult celiac disease.  The thought is that
when a person with the required version of an HLA gene
is infected with this specific virus, the bit of the
virus that fits into that "platter" has some strong
similarities with a section of the gluten molecule,
and the combined attack of the immune system against
that adenovirus and the matching gluten molecule sets
up the pathology that is recognized as celiac sprue.

Again, that is not observed in every patient - not
even an overwhelming majority.

It appears, then, that the development of celiac sprue
is multifactorial,involving both genetic components
and environmental ones.  A person could have the
genetic testing to see if they are susceptible to
celiac sprue, but there needs to be confirmation of
the diagnosis from biopsy and symptoms as well.

The one American lab I ran across was:

Department of Cell Biology,
University of Virginia, Charlottesville, VA 22908,
USA.

There were a lot of European ones - here are three
likely ones:

Gastroenterology Unit, UMDS, London;

Section of Cancer Genetics, Institute of Cancer
Research, Sutton, Surrey.

Division of Medical and Molecular Genetics, The Guy's,
King's and St. Thomas's School of Medicine, King's
College, London, United Kingdom.

________________________________________

I have no reason to believe that Dr. Fine is not a
top-notch physician and researcher, nor do I have any
information that would indicate that his DNA testing
isn't valid; however, when my PCP spoke with Dr.

Murray at Mayo, Dr. Murray did not seem convinced that
a good DNA test for celiac was available at this time.

Thus, my skepticism and need for choices in labs.

Being a daughter of a physician (who is now deceased),
I am extremely wary of having only one resource for
any type of medical testing. My opinion at this point
is, if DNA testing for celiac is fairly reliable and a
standard protocol exists, more than one lab would be
performing the test on a regular basis.

I hope this information has been helpful and has not
confused those who requested a summary.

Thanks, again, to all who took the time to reply.

Cheers,
Ayn/Kansas

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