CICA Overview

Two out of five Americans have gastrointestinal disorders: up to 20% are affected by IBS, 0.44% impacted by Crohn’s and ulcerative colitis, and up to 1% with celiac disease.

Accurate diagnosis of non-celiac gluten sensitivity (NCGS) and celiac disease is complex because both specific and nonspecific pathways of the immune system are involved.

The CICA evaluates a patient’s genetic risk for celiac disease, serum markers associated with active celiac disease process, and genetic serum markers associated with Crohn’s disease, and serological markers for diminished antigen exclusion in the gut.

Optionally, it can be combined with the Alcat Test to evaluate innate immune cell responses to foods and other substances for the most comprehensive assessment.



CICA Test Components


1. Genetic

More than 95% of patients with celiac disease possess HLA-DQ2.5 and/or HLA-DQ8 genotype. More than 90% of those with celiac have the DQ2.5 genotype. Absent these markers, development of celiac is highly unlikely.

Crohn’s disease is triggered by a variety of environmental and genetic factors. It is described as a chronic inflammatory bowel disease (IBD) caused by a dysregulation of the immune response to intestinal flora and in parallel, accompanied by a defect of the epithelial barrier.

The predominant genetic markers are:

  • NOD2/CARD15 associated with the innate immune system and the activation of nuclear factor кB (NF- кB).
  • T300A mutation in the ATG16L1 gene increases its susceptibility to degradation by Caspase 3 and thus is associated with autophagy.

2. Serologic/Antibody

Tissue transglutaminase antibody (tTG) – IgA & IgG

In active celiac disease, damaged enterocytes produce tTG, therefore antibodies against tTG (IgA and/or IgG) are indicative of an active disease process. In patients with normal total IgA levels and negative tTG antibodies, the diagnosis of active celiac disease is unlikely. However, a certain percentage of patients with celiac disease may be seronegative. If tTG IgA is negative, while celiac disease is suspected, then additional markers included in this panel become more relevant in the diagnosis of gluten-related disorders.

Deaminated gliadin peptide (DGP) antibody - IgA & IgG

Deaminated gliadin can bind with tTG and become immunogenic. Therefore, detecting the presence of elevated IgA and/or IgG antibodies against DGP is an additional indicator of an active celiac disease process.

Anti-Saccharomyces Cerevisiae Antibody (ASCA)

ASCA is an indicator for the presence of Crohn’s disease. The presence of ASCA may also reflect increased intestinal inflammation and permeability, including that associated with active celiac disease.

Total Serum IgA

It is common for celiac disease patients to be IgA deficient. It is the most common immunologic deficiency (1:400-1:700 in the general population and 1:50 in celiac disease patients) and may be the single largest contributor to false negative results in biopsy confirmed celiac disease patients. Total Serum IgA is used as a measurement to qualify IgA testing for tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) antibody levels. When IgA levels are low or deficient, it is important to check IgG levels for both tTG and DGP (included in this array).

3. Cellular

(Optional)

The Alcat Test for determination of cellular responses to foods and chemicals*

*When ordering any Alcat food panel together with the CICA, the lab fee of $75 can be waived from the total cost.



Who Should Test?

  • Those with gastrointestinal symptoms and autoimmune disorders that might suggest a problem with gluten
  • Those with increased intestinal permeability which has been linked to autoimmune disorders and other conditions
  • Those suspected to have Crohn’s or celiac disease
  • Those suffering from symptoms of IBS including diarrhea, bloating or cramping
  • Those with chronic fatigue
  • Those with malabsorption of nutrients or iron deficiency

Are you currently on a gluten free or gluten restricted diet? Learn more

Because antibody titers are exposure related, purposeful avoidance of gluten can cause a decrease of serological results. Therefore, the patient’s exposure to gluten containing grains should be considered when interpreting tTg and DGP serology results.

Our recommendations:

  • For genetic component only: gluten consumption prior to testing would not impact the results. Continue with current eating pattern. No change in gluten consumption is necessary.
  • To assess the impact of gluten on tTg and DGP antibodies and the likelihood of active celiac disease: A study conducted on 20 adults with biopsy-proven celiac disease showed that a 14 day gluten challenge of ≥ 3 grams increased antibody titers in 2/3 of the subjects on day 14 and 90% of the subjects on day 28. For those without a current diagnosis of celiac disease or wheat allergy, who have been avoiding gluten, a consumption of gluten (≥ 1 ½ slices of wheat bread or equivalent daily) for a minimum of the first two weeks of the last four weeks, prior to testing, is recommended.

Note:
Of the 4 celiac disease antibodies that are measured within the CICA, tTg-IgA is the most highly studied and most of our knowledge of the temporal relationship between the presence of antibody and the exposure to gluten come from that antibody. It is likely that the other antibodies have a similar pattern, but we cannot be certain.

For those in this category, who have been avoiding gluten for an extended period of time and who feel adverse reactions when gluten is consumed, a consultation with the health care provider regarding the re-introduction of gluten to the eating pattern prior to testing, is recommended. Perhaps another way to approach the issue of gluten avoidance prior to testing is to recommend testing in the individual’s current avoidance state. If the antibody results are positive then the avoidance did not have a significant effect. If the test is negative, then it is unknown whether the avoidance had an effect, so it might be helpful to retest after an interval of gluten exposure.


  • For individuals with a high genetic risk and family history of celiac or related autoimmune disease (e.g. type 1 diabetes), periodic bi-annual follow- up serologic screening is recommended.
  • For those with a diagnosis of celiac disease, using this test to monitor and assess impact of the gluten free lifestyle on tTg and DGP antibodies, continue to follow the gluten free lifestyle. The strictness of the gluten free lifestyle to prevent celiac disease activity may not be equal for all individuals with the disease. Reports range from a few months to a year or more for the antibody level to go from positive to negative. For those with a diagnosis of celiac disease, please consult your physician to determine if this test is appropriate for you.

Leffler Daniel A., Schuppan D., et al Kinetics of the histologic, serologic and symptomatic responses to gluten challenge in adults with celiac disease. Gut. 2013 July; 62 (7): 996-1004. Celiac Center and Division of Gastroenterology, Beth Israel Deaconess Medical Center.
http://www.ncbi.nlm.nih.gov/pubmed/22619366
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088693/


Testing Options & Test Results

Option 1: Celiac, IBS, and Crohn’s Array (CICA)
(Genetic + Serologic)

Option 2: CICA – Genetic Only

Option 3: CICA – Serologic/Antibody Only

CICA test results are color-coded and easy to read. Each result is thoroughly explained with expert commentary.

About Our lab

Cell Science Systems Corp. is a specialty clinical laboratory that develops and performs testing in immunology, serology, cell biology and other specialties supporting the personalized treatment and prevention of chronic disease.

Cell Science Systems Corp. operates a CLIA certified laboratory and is an FDA inspected and registered, cGMP medical device manufacturer meeting ISO EN13485 2012 standards.

Committed to Quality

Cell Science Systems fulfills high quality state and federal standards.

  • CLIA-ID#10D0283906
  • State of Florida Lab ID: 800001500
  • State of California Lab ID: COS 00800633
  • EN13485
  • CE Marked. TUV Certified and safety monitored
  • Supported by the EU and the State of Brandenburg
  • ISO 13485:2012 + AC:2010 Certification as a Medical Device Manufacturer

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Disclaimer

The CICA does not provide a diagnosis of celiac disease or any other symptoms. It is for informational purposes only and does not constitute medical advice or treatment in any way. If the test results indicate a strong celiac disease or Crohn’s disease susceptibility a thorough clinical evaluation should follow.