Tissue Transglutaminase Antibodies in Celiac Disease

Abstract

Because of the high sensitivity (approximately 95%) and technical simplicity, tissue transglutaminase antibodies may prove useful for the screening of celiac disease in population at low or medium risk of celiac disease. To avoid duodenal biopsies in patients without celiac disease, the specificity of the screening procedure may be increased by confirming with antiendomysial antibodies by immunofluorescence on human umbilical cord in individuals with results between 0.4 and 0.7 optical density.

Human tissue transglutaminase enzyme linked immunosorbent assay outperforms both the guinea pig based tissue transglutaminase assay and anti-endomysium antibodies when screening for coeliac disease

“…The results from those four studies [3,17,24,26], giving a sensitivity of 85%-95% and a specificity of 90%-98%, are comparable with our results for guinea pig based tTG (sensitivity of 96% and a specificity of 92%). Furthermore, several non-biopsy controlled studies describing the use of a guinea pig IgA tTG ELISA have been published recently, giving comparable sensitivities and specificities [10,12,14,15,23,27].…”

“…As guinea pig tTG, but not human tTG, was directly available, the first enzyme linked immunosorbent assays (ELISAs) developed used this substrate. However, the sensitivity of this test did not exceed that of the EMA [3,10,14,17,25]. These results might have been caused by the only partial homology between guinea pig tTG and human tTG.…”

“…Therefore, after the recent identification of tTG as the auto-antigen of CD [11], a guinea pig based tTG ELISA was developed by several groups, hoping that this would provide a more reliable serological test for CD. However, sensitivity and specificity were not superior to IgA EMA [3,10,14,17,25], probably due to only partial homology between guinea pig tTG and human tTG. Thus, the next step was the development of an ELISA based on human tTG.…”

Do you still need a biopsy to diagnose celiac disease?

“…In fact, unlike the well-differentiated, mature absorptive cells, the undifferentiated crypt cells are markedly increased in number in untreated CD, and this accounts for the obvious lengthening of crypts. The cellularity of the lamina propria is increased, and the [25] 95 90 Brusco et al [26] 100 95 Chan et al [27] 89 94 Dieterich et al [23] 98 95 Gillett and Freeman [28] 95 100 Seissler et al [29] 96 99.6 Stern [17••] 93 95 Sulkanen et al [30] 95 94 Troncone et al [31] 92 98 Vitoria et al [32] 100 94 Fabiani and Catassi [33] 90 96 Average (unweighted) 95.17 95.55 thickness of the mucosa overall is also increased. The cellular infiltrate consists largely of plasma cells and lymphocytes.…”

Coeliac Disease in Patients with Autoimmune Thyroiditis

“…Recently, after the identification of tissue transglutaminase (tTG) as the predominant endomysial autoantigen [14], various enzyme-linked immunosorbent assays (ELISAs) for anti-tTG antibodies, using commercial guinea pig liver or human tTG as antigens, have been set up [15, 16]. The sensitivity of IgA anti-tTG for untreated coeliac disease, evaluated above all in retrospective studies, has been found to be identical or slightly higher than that of IgA EmA, whereas the former showed a slightly lower specificity than the latter [17, 18]. …”