The Repertoire of Autoantibodies in Celiac Disease: Any New One?

Presented at the 13th International Congress on Autoimmunity in Athens, Greece

Speaker: Aaron Lerner

Key Takeaways:

• Current celiac disease (CD) guidelines recommend blood-based antibody tests for screening and diagnosis.
• Standard serologic tests include:
  • tTG-IgA and tTG-IgG – tTG-IgA is considered the “gold standard,” but normal ranges are not well defined, cutoff levels vary by manufacturer, and test standardization is lacking.
  • EMA-IgA – highly accurate, but results depend on the observer, making it subjective, plus it is costly and time-intensive.
  • DGP-IgA and DGP-IgG – used less often due to poor predictive value in children and limited ability to distinguish CD from non-CD.
• These limitations highlight the need for new diagnostic tools.

The current standard of classical serological markers for diagnosing CD has its limitations. Therefore, a new generation of markers should be considered and developed.

83% of Americans who have CD are undiagnosed or misdiagnosed with other conditions. Late diagnosis has long-term complications: short stature, osteoporosis, enamel defects, nutritional deficiencies, cancer predisposition, and susceptibility to other autoimmune diseases.

Lerner proposed that the tTG neo-epitope should be considered as a new diagnostic marker for CD.

Proposed New Marker: tTG neo-epitope

• Shows higher sensitivity and specificity, especially in children
• Strong correlation with Marsh criteria (grading of intestinal damage)
• Effective as an early marker for silent or latent CD
• Potential to serve as a superior screening assay

Citation

Agardh, D., Matthias, T., Wusterhausen, P., Neidhöfer, S., Heller, A., & Lerner, A. (2020). Antibodies against neo-epitope of microbial and human transglutaminase complexes as biomarkers of childhood celiac disease. Clinical and experimental immunology, 199(3), 294–302. https://doi.org/10.1111/cei.13394