Intestinal transglutaminase 2 specific antibody deposits in non-responsive coeliac disease.
OBJECTIVE
The diagnosis of coeliac disease is problematic in individuals not responding to a gluten-free diet. Small-bowel villous atrophy occurs in other enteropathies and non-responsive patients are often seronegative. We investigated whether small-bowel mucosal transglutaminase-2 specific autoantibody deposits distinguish non-responsive coeliac disease from other enteropathies.


METHODS
Small-bowel mucosal autoantibody deposits were determined in 27 non-responsive, 28 responsive coeliac patients and 10 controls with other enteropathies. Of the non-responsive coeliac patients six were adhering poorly and 21 strictly to the diet; six of the 21 had enteropathy-associated lymphoma, five refractory coeliac disease and 10 otherwise persistent villous atrophy. The presence of mucosal autoantibody deposits was compared to serology, villous morphology, densities of intraepithelial lymphocytes (IELs) and markers of refractory coeliac disease.


RESULTS
Twenty out of 21 well-adhering, all six poorly adhering non-responsive and all 28 untreated responsive coeliac patients had small-bowel mucosal autoantibody deposits present, while controls with other enteropathies were negative. Small-bowel mucosal autoantibody deposits were more accurate in detecting coeliac disease than serology or IEL densities. Refractory coeliac markers revealed only cases with the most severe condition.


CONCLUSIONS
Small-bowel mucosal autoantibody deposits differentiate coeliac disease from other enteropathies, enabling the design of appropriate therapeutic strategies.
Koskinen
Outi
O
Pediatric Research Center and Medical School, University of Tampere, FIN-33014 Tampere, Finland.
Lindfors
Katri
K
Collin
Pekka
P
Peräaho
Markku
M
Laurila
Kaija
K
Woolley
Niina
N
Partanen
Jukka
J
Mäki
Markku
M
Kaukinen
Katri
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D002446:Celiac Disease / Q000201:enzymology / Q000276:immunology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins / Q000276:immunology* / Q000378:metabolism; D006650:Histocompatibility Testing; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007413:Intestinal Mucosa / Q000201:enzymology* / Q000276:immunology; D007421:Intestine, Small / Q000201:enzymology / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology* / Q000378:metabolism; D055815:Young Adult
D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins