Antibodies against Synthetic Deamidated Gliadin Peptides for Celiac Disease Diagnosis and Follow-Up in Children

Basso, Daniela; Guariso, Graziella; Fogar, Paola; Meneghel, Alessandra; Zambon, Carlo–Federico; Navaglia, Filippo; Greco, Eliana; Schiavon, Stefania; Rugge, Massimo; Plebani, Mario

doi:10.1373/clinchem.2008.110395

Cited by 75 publications

(94 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The high diagnostic sensitivity obtained with the IgG-anti-dGli assay is comparable with results of previous smaller studies on IgA-deficient CD patients (9,19 ) and with reports on individual IgA-deficient cases (17,18 ) applying another test based on dGli as the antigen.…”

supporting

confidence: 87%

See 1 more Smart Citation

IgG Antibodies against Deamidated Gliadin Peptides for Diagnosis of Celiac Disease in Patients with IgA Deficiency

et al. 2010

View full text Add to dashboard Cite

Background: Assays for IgG antibodies against deamidated gliadin (IgG-anti-dGli) are comparable in performance with tests detecting IgA antibodies against tissue transglutaminase (IgA-anti-tTG) in diagnosing celiac disease (CD). IgA-anti-tTG are absent in IgA deficiency, a condition often associated with CD. In IgA deficiency, IgG-anti-tTG, which have a lower overall diagnostic accuracy, are routinely measured. We examined whether IgG-anti-dGli would be useful for diagnosing CD in patients with IgA deficiency.Methods: We studied 34 IgA-deficient CD patients, 185 IgA-competent newly diagnosed children with CD, 316 children without CD, 400 adult blood donors, and 6 control IgA-deficient individuals without CD. Anti-dGli and anti-tTG were measured by ELISA, and endomysium antibodies (EmA) were measured by immunofluorescence on monkey esophagus (IgA as well as IgG class for all antibodies). We calculated diagnostic sensitivity (percentage of patients above cutoff with 95% CIs) according to age-specific cutoffs for 95% diagnostic specificity and according to cutoffs proposed by the manufacturer of the assays.Results: No IgA-deficient CD patients were positive for any IgA-based antibody assay. Diagnostic sensitivity of IgG-anti-tTG was 91.2% (95% CI 76.3%–97.7%) according to age-specific cutoffs and 82.4% (66.1%–92.0%) according to manufacturer cutoffs. The diagnostic sensitivity of IgG-EmA was 75.8% (58.8%–87.4%) and the sensitivity of IgG-anti-dGli was 88.2% (72.8%–95.9%) according to both cutoffs.Conclusions: IgG-anti-dGli and IgG-anti-tTG have comparable diagnostic sensitivities for IgA-deficient celiac patients. IgG-anti-dGli may be useful for diagnosing CD in IgA-deficient patients.

show abstract

supporting

confidence: 87%

“…Recently, 8 IgA-deficient CD children were described (11,17,18 ) who all had low concentrations of IgA-anti-tTG and IgA-anti-dGli but high concentrations of IgG-anti-dGli. Two further studies, each including 20 IgA-deficient CD patients, revealed higher accuracy of IgG-anti-dGli detection compared with antibodies against native gliadin (9,19 ).…”

mentioning

confidence: 99%

IgG Antibodies against Deamidated Gliadin Peptides for Diagnosis of Celiac Disease in Patients with IgA Deficiency

et al. 2010

View full text Add to dashboard Cite

show abstract

“…The DGP concentrations declined and became negative more rapidly than the tTG concentrations. This difference in Ab kinetics has been described earlier (2,8).…”

supporting

confidence: 73%

Positive Deamidated Gliadin Peptide Antibodies and Negative Tissue Transglutaminase IgA Antibodies in a Pediatric Population: To Biopsy or Not To Biopsy

Parizade

Shainberg

2010

Clin Vaccine Immunol

View full text Add to dashboard Cite

Reports from our clinical laboratory database show that 75% of children <2 years old tested for celiac serology who were found positive for deamidated gliadin peptide (DGP) antibodies had negative results for tissue transglutaminase IgA. DGP levels were shown to decline and disappear without a gluten-free diet. This observation questions DGP's specificity for diagnosis of celiac disease.Celiac serology tests are the necessary tool for correctly referring individuals for duodenal biopsies when diagnosing celiac disease (4). Testing for tissue transglutaminase IgA (tTG) antibodies (Abs) is currently the test of choice used for this purpose (5, 17). Since there are reports indicating lack of tTG sensitivity in infants (3, 7), we decided that all serum samples from infants Ͻ2 years old referred to our clinical laboratory for celiac disease testing should be additionally tested for deamidated gliadin peptide (DGP) (IgG and IgA) Abs (6, 13). Gliadin Abs exhibit weak performance (4), and endomysial IgA (EMA) testing adds limited diagnostic value to the tissue transglutaminase (tTG) assay (12,19); therefore, these assays were not included in our laboratory practice. Total IgA was measured to identify IgA deficiency (5). In many cases, inconsistency between serology results, namely, DGP positive/tTG negative, was observed. We have retrospectively analyzed this observation by contacting the referring physicians and learning the clinical outcome for these infants.Over a period of 17 months (July 2007 to December 2008), we tested serum samples from 5,036 infants (Ͻ2 years old) for celiac disease-specific Abs using two commercial enzymelinked immunosorbent assay (ELISA) kits, one for DGP Abs (Quanta Lite DGP IgGϩIgA screen [Inova Diagnostics, San Diego, CA]: intraassay coefficient of variation [CV], 0.5 to 4.7%; interassay CV, 2.4 to 5.8%; standard deviation, 0.1 to 3.8) and one for tTG Abs (Celikey tTG-IgA; Phadia, Freiburg, Germany). We compiled reports from the laboratory's database, listing all infants with contradicting positive and negative results.The DGP results were positive in 202 infants; of these, only 35 (17%) were positive for tTG (Fig. 1). Positive results for both Ab entities are highly suggestive of celiac disease and indicate the desirability of performing duodenal biopsies. Since these cases were not of interest in our study, no further follow-up was conducted. IgA deficiency (IgA at Ͻ6 mg/dl, determined with a BNII nephelometer; Siemens) was determined in 15 (7.4%) infants. These infants were referred for biopsies in order to make a final diagnosis. In the remaining 152 (75%) infants, tTG was negative (Ͻ3 U/ml) (Fig. 1). We contacted the referring physicians in order to discover the clinical outcome in 80 of these cases with contradictory serology results. Twelve infants were referred for duodenal biopsies, mainly due to their physician's approach, claiming that when clinical features are present, one positive serology measurement is an adequate indication for performing biopsies. Celiac disease was diagn...

show abstract

“…The anti-DGP antibody test provides a more specific marker for disease compared to its predecessor, the antigliadin antibody assay. Although the anti-DGP antibody test is not currently recommended for routine screening, it may be useful for patients in whom suspicion of CD is high, but anti-tTG and/or EMA is not detected (39,40).…”

Section: Celiac Disease Serologic Tests and Recommendations For Screementioning

confidence: 99%

“…Early clinical studies suggested that EMA and AGA tests are useful in very young children (Table 1); however, more-recent data indicate that anti-tTG or DGP IgA immunoassay is similar and in some cases more accurate than the AGA immunoassay (29, c The positive predictive value (PPV) and negative predictive value (NPV) both had a pretest probability of 5%. 30,39,40,42,43). In one of the most recent studies examining the significance of AGA, EMA, and ARA in genetically at risk children for CD from birth, AGA IgG appeared Ն3 months earlier than anti-tTG, with anti-tTG, EMA, and ARA emerging concurrently (44).…”

Section: Testing For Antireticulin Antibodies Is Obsolete In the Evalmentioning

confidence: 99%

Testing for Antireticulin Antibodies in Patients with Celiac Disease Is Obsolete: a Review of Recommendations for Serologic Screening and the Literature

Nandiwada

Tebo

2013

Clin Vaccine Immunol

View full text Add to dashboard Cite

Celiac disease (CD) is an autoimmune disorder that occurs in genetically susceptible individuals of all ages and is triggered by immune response to gluten and related proteins. The disease is characterized by the presence of HLA-DQ2 and/or -DQ8 haplotypes, diverse clinical manifestations, gluten-sensitive enteropathy, and production of several autoantibodies of which endomysial, tissue transglutaminase, and deamidated gliadin peptide antibodies are considered specific. Although antireticulin antibodies (ARA) have historically been used in the evaluation of CD, these assays lack optimal sensitivities and specificities for routine diagnostic use. This minireview highlights the advances in CD-specific serologic testing and the rationale for eliminating ARA from CD evaluation consistent with recommendations for diagnosis.

show abstract

Antibodies against Synthetic Deamidated Gliadin Peptides for Celiac Disease Diagnosis and Follow-Up in Children

Cited by 75 publications

References 40 publications

IgG Antibodies against Deamidated Gliadin Peptides for Diagnosis of Celiac Disease in Patients with IgA Deficiency

IgG Antibodies against Deamidated Gliadin Peptides for Diagnosis of Celiac Disease in Patients with IgA Deficiency

Positive Deamidated Gliadin Peptide Antibodies and Negative Tissue Transglutaminase IgA Antibodies in a Pediatric Population: To Biopsy or Not To Biopsy

Testing for Antireticulin Antibodies in Patients with Celiac Disease Is Obsolete: a Review of Recommendations for Serologic Screening and the Literature

Contact Info

Product

Resources

About