Anti-Transglutaminase Antibody Assay of the Culture Medium of Intestinal Biopsy Specimens Can Improve the Accuracy of Celiac Disease Diagnosis

Abstract

Background:We measured anti-transglutaminase (antitTG) antibody in the culture medium of intestinal biopsy specimens from patients with suspected celiac disease (CD) and evaluated the relationship between antibody production and severity of intestinal mucosal damage. Methods: We performed diagnostic testing for CD on 273 consecutive patients. In addition to routine histologic evaluation of duodenal biopsy specimens, we assayed anti-tTG antibodies in serum and in the culture medium of duodenal biopsy specimens. Results: CD was diagnosed in 191 of the 273 patients. Sensitivity and specificity of the serum anti-endomysium (EmA) and anti-tTG assays were 83% and 85% and 99% and 95%, respectively, and both had 88% diagnostic accuracy. EmA and anti-tTG assayed in the culture medium had 98% sensitivity, 100% specificity, and 98% diagnostic accuracy (vs serum assays; P <0.0001). Twenty-nine CD patient specimens (16%) were negative for serum anti-tTG and EmA; for 24 of these patients, anti-tTG assay of the culture medium was positive. The CD patients whose biopsy specimens were positive for serum antibodies showed the following intestinal histologies: total villous atrophy, 35%; severe villous atrophy, 25%; mild atrophy, 25%; villi with no atrophy but with increased intraepithelial lymphocytes, 15%. None

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease

“…More recently, similar data have been obtained measuring IgA anti-TG2 antibodies in supernatants of cultured biopsies from CD patients untreated and on a gluten-free diet [15][16][17]. This test has been proposed for diagnostic purposes, particularly in patients with normal mucosa.…”

“…Therefore, it is particularly important to find the most suitable assay to detect and measure these antibodies. In the last 20 years different assays have been used: measurement in faeces [23] or in intestinal fluids [24], search in supernatants of cultured biopsy fragments [11][12][13][14][15][16][17] or detection in the same biopsies of deposited antibodies [16], or expression in phage libraries of RNA, obtained from biopsies, coding for the antibodies [6,22]. Detection of anti-endomysium antibodies (EMA) and anti-TG2 IgA antibodies in faecal supernatants from CD patients was determined to be unreliable as a diagnostic test [25].…”

“…Detection of anti-endomysium antibodies (EMA) and anti-TG2 IgA antibodies in faecal supernatants from CD patients was determined to be unreliable as a diagnostic test [25]. The search for anti-TG2 antibodies in culture supernatants of intestinal biopsy from CD patients by ELISA was proposed in particular to improve the accuracy of CD diagnosis in subjects with mild enteropathy and in patients negative for serum antibodies [15][16][17]. More recently, using immunofluorescence, Korponay-Szabo et al [7] showed that IgA deposited in the intestine of CD patients are directed against TG2.…”

In Vitro Gluten Challenge Test for Celiac Disease Diagnosis

“…The HLA-DR expression was graded from absent to very strong (0-3) (3). ICAM-1 and CD3/CD25-positive cells were counted per square millimeter of mucosa (15)(16)(17)(18)(19).…”

Seronegative celiac disease: a case report

“…[8][9][10] Different studies have shown prevalence of seronegative CD 6.4%, 12%, 15%. [9][10][11][12] It is believed that, the presence of related CD antibodies correlates with the degree of villous atrophy and possibly the mode of presentation of the disease. 13,14 if CD suspicion is high with persistently negative tests, individuals must perform typing for HLA and, if positive, they must perform duodenal biopsy or alternatively perform biopsy directly.…”