Abstract
Objectives
Tissue transglutaminase (tTG) IgA antibodies are a hallmark for celiac disease (CD). In CD patients on gluten free diet (GFD) these antibodies are transient. Few studies are available comparing the tTG-IgA assay characteristics for monitoring response to GFD. Since discrepant results were reported in patients on GFD after switching tTG-IgA assays, we conducted a retrospective observational study to monitor GFD response using three different tTG-IgA assays.
Methods
Diagnostic samples from 44 adults and 17 children with CD were included. Of most patients two follow-up samples after introduction of GFD were available. In all samples tTG-IgA were assessed using one fluorochrome-enzyme immuno-assay (FEIA) and two chemiluminescence immuno-assays (CLIA) and intestinal fatty acid binding protein (i-FABP) as surrogate marker for intestinal epithelial damage was measured.
Results
Using CLIA assays, normalization of antibody levels was delayed compared to FEIA (p<0.001). Of all samples taken after at least 6 months on GFD with elevated i-FABP indicating intestinal epithelial damage, 40 % had positive tTG-IgA according to the FEIA, 85 and 90 % according to the two CLIA.
Conclusions
Normalization of tTG-IgA in patients on GFD depends on the assay used. Both CLIA appear to be more sensitive in detecting suboptimal treatment response in CD-indicated by elevated i-FABP – when applying the manufacturer’s recommended cut-off for the diagnosis of CD.
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Research ethics: The study complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration.
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Informed consent: Because of the anonymous nature of the data and the opt-out option described on our institutions’ homepages and request forms, the requirement for additional informed consent to participate in this study was deemed unnecessary according to the Dutch ‘‘Ethical Guidelines for Responsible Handling of Human Tissue for Scientific Research”.
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Author contributions: Conceptualization: LM, JD and HB. Methodology: LM, JD, MV and HB Laboratory analysis: JH, TK, and CB. Data analysis: LM. Statistics: MV. Data Curation: LM, Writing – Original Draft Preparation: LM, Writing - Review and editing: JD, HB, DC and PvdP. The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors report no conflict of interest relevant for the study presented. JD reports consultancy and/or speakers fees from Werfen/Inova, Thermo Fisher Scientific, and Euroimmun Medizinische Labordiagnostika.
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Research funding: All tTG-IgA reagents were kindly provided by Thermo Fisher Scientific, Inova Diagnostics and Euroimmun Medizinische Labordiagnostika.
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Data availability: The raw data can be obtained on request from the corresponding author.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/cclm-2023-1076).
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