Gastroenterology

Gastroenterology

Volume 115, Issue 6, December 1998, Pages 1317-1321
Gastroenterology

Rapid Communications
Autoantibodies to tissue transglutaminase as predictors of celiac disease,☆☆

https://doi.org/10.1016/S0016-5085(98)70007-1Get rights and content

Abstract

Background & Aims: Immunoglobulin A (IgA) autoantibodies to endomysium (EMA) are highly specific and sensitive markers for celiac disease. Recently, we identified tissue transglutaminase (tTG) as the major if not sole endomysial autoantigen. Methods: An enzyme-linked immunosorbent assay (ELISA) was established to measure IgA anti-tTG titers in serum samples from 106 celiac patients with partial or subtotal villous atrophy, 43 celiac patients on a gluten-free diet, and 114 diseased and healthy controls. Results were correlated with clinical and histological data and with EMA titers. Results: In patients with biopsy-proven celiac disease consuming a normal, gluten-containing diet, 98.1% of the serum samples had elevated IgA titers against tTG, whereas 94.7% of the control sera were negative. IgA anti-tTG correlated positively with semiquantitative IgA EMA titers (r = 0.862; P < 0.0001). Conclusions: An ELISA based on tTG allows diagnosis of celiac disease with a high sensitivity and specificity. IgA anti-tTG and IgA EMA show an excellent correlation, further confirming the enzyme as the celiac disease autoantigen. Because the assay is quantitative, not subjected to interobserver variation, and easy to perform, it will be a useful tool for population screening of a hitherto underdiagnosed disease.

GASTROENTEROLOGY 1998;115:1317-1321

Section snippets

Patients

A total of 106 serum samples from untreated celiac patients (71 female and 35 male) were examined. The patients had different clinical and histopathologic degrees of severity (malabsorption or partial or subtotal villous atrophy) and responded with clinical improvement to gluten withdrawal. The mean age was 32.6 years, ranging from 4 to 80 years. In addition, serum samples from 43 celiac patients (34 female and 9 male; age, 7–79 years; mean age, 34.3 years) consuming a gluten-free diet for 6–12

Results

An ELISA based on serum IgA autoantibodies against tTG was performed; the results are summarized in Table 2. The ELISA procedure was improved from the protocol used in our previous study.9 Blocking with bovine serum albumin was avoided because some serum samples from patients with celiac disease and controls showed antibodies against this food component, therefore possibly falsifying the results. Also, the addition of calcium to the coating buffer was mandatory to improve the sensitivity of the

Discussion

We used an ELISA based on tTG, the recently discovered endomysial autoantigen in celiac disease, to determine (1) the extent to which detectable IgA anti-tTG was predictive of a positive EMA test result by immunofluorescent examination and (2) to establish the titers of IgA anti-tTG in serum samples from patients with celiac disease and from various controls.

Collectively, IgA anti-tTG titers showed a good correlation with EMA titers, reaching a sensitivity of 98.1% and a specificity of 94.7%.

References (22)

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    • Pathophysiology and immunogenetics of celiac disease

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      According to research, tTG is not only a diagnostic marker for CD, but it also plays a role in the disease's etiology [38]. tTG may aggravate the inflammatory process in CD patients by damaging the extracellular villous matrix and acting as a target for intestinal villous epithelial cells to be destroyed [39]. Indeed, the aforementioned reactions are significant, first, tTG may eliminate particular glutamine residues from immunogenic gliadin peptides, resulting in epitopes with a higher affinity for DQ2 [40,41].

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    Address requests for reprints to: Detlef Schuppan, M.D., Ph.D., Medizinische Klinik I, University of Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. e-mail: [email protected]; fax: (49) 9131-8536003.

    ☆☆

    Supported by grants SFB 366 C5 and Schu 646/4-1 from the Deutsche Forschungsgesellschaft and by a grant from the German Celiac Society.

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