Non-Invasive Biomarkers for Celiac Disease

Abstract

Once thought to be uncommon, celiac disease has now become a common disease globally. While avoidance of the gluten-containing diet is the only effective treatment so far, many new targets are being explored for the development of new drugs for its treatment. The endpoints of therapy include not only reversal of symptoms, normalization of immunological abnormalities and healing of mucosa, but also maintenance of remission of the disease by strict adherence of the gluten-free diet (GFD). There is no single gold standard test for the diagnosis of celiac disease and the diagnosis is based on the presence of a combination of characteristics including the presence of a celiac-specific antibody (anti-tissue transglutaminase antibody, anti-endomysial antibody or anti-deamidated gliadin peptide antibody) and demonstration of villous abnormalities. While the demonstration of enteropathy is an important criterion for a definite diagnosis of celiac disease, it requires endoscopic examination which is perceived as an invasive procedure. The capability of prediction of enteropathy by the presence of the high titer of anti-tissue transglutaminase antibody led to an option of making a diagnosis even without obtaining mucosal biopsies. While present day diagnostic tests are great, they, however, have certain limitations. Therefore, there is a need for biomarkers for screening of patients, prediction of enteropathy, and monitoring of patients for adherence of the gluten-free diet. Efforts are now being made to explore various biomarkers which reflect different changes that occur in the intestinal mucosa using modern day tools including transcriptomics, proteomics, and metabolomics. In the present review, we have discussed comprehensively the pros and cons of available biomarkers and also summarized the current status of emerging biomarkers for the screening, diagnosis, and monitoring of celiac disease.

Lane-Hamilton Syndrome: An Illustration of Extraintestinal Manifestations of Celiac Disease

“…However, it is known that there are 9 types of transglutaminase genes in mammals. 23 They play different roles in the body. For example, transglutaminase 6 is expressed in the brain and has been found in patients with gluten ataxia.…”

“…Tranglutaminase 3, epidermal, is reported in dermatitis herpetiformis. 23 Transglutaminase 2 is ubiquitous in all tissues and cells and is known as tissue transglutaminase or TTG. Thus, TTG could play a role in the various organ systems in manifestation of CD, or the individual transglutaminases could contribute.…”

“…Thus, TTG could play a role in the various organ systems in manifestation of CD, or the individual transglutaminases could contribute. 23…”

Celiac disease TG2 autoantibodies development: it takes two to tango

“…The identification of autoantibodies against TG2 in CD was first reported by Dieterich et al in 1997 8 . Since then, the detection of the IgA anti-TG2 Ab has become the most widely used test both for the diagnosis and initial screening for CD because of its very high sensitivity and specificity 9 . Despite the accepted evidence of the involvement of TG2 in the CD, there are still many open questions about its role in the disease's pathogenesis.…”

Small Bowel—Key Player in Health and Disease

“…Included also in this special issue, Singh et al [20] comprehensively reviewed the pros and cons of biomarkers in coeliac disease and summarized the current status of coeliac disease screening, diagnosis, and monitoring. The review could guide clinicians in diagnosis and monitoring of patients with coeliac disease.…”