Tissue transglutaminase-serology markers for coeliac disease

Serology markers of coeliac disease (CD) antigliadin IgA/IgG antibodies (AGA/AGG) with purified [alpha]gliadin, antiendomysium IgA antibodies (EmA) and antitissue transglutaminase (atTG) IgA/IgG antibodies determined in 1451 serum samples, were analysed with respect to different screening algorithms. Determination of atTG using five ELISA methods was compared taking into account the impact of human recombinant antigen and IgG class of atTG. A subgroup of 119 patients undergoing small intestinal biopsy was used to calculate sensitivity and specificity of CD markers. The highest sensitivity (94%) was obtained for AGG, and the highest specificity (93.5%) was obtained for EmA. All coeliac disease patients were detected using the combination of all four CD markers, resulting in 100% sensitivity. CD and type 1 diabetes mellitus autoantigens were determined in 139 diabetic patients. The atTG IgA mean value (16.7 IU/ml) was higher in the antiglutamate dehydrogenase antibody (GAD)positive subgroup, where at least one CD marker was positive in 83.6% subjects. In the GADnegative subgroup atTG IgA was 8.73 IU/ml and at least one CD marker was positive in 57.4% subjects. atTG in IgA and IgG classes could be recommended as valuable serological markers of CD in the differential diagnosis of malabsorption as well as in various screening algorithms. ELISA determination of atTG with human antigen could increase the specificity, especially in patients with other autoimmune diseases.