title: Novel assay for detecting celiac disease-associated autoantibodies in dermatitis herpetiformis using deamidated gliadin-analogous fusion peptides.
abstract: BACKGROUND
  Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease (CD), the latter being identified by circulating autoantibodies against native gliadin (nGli), tissue transglutaminase (tTG), endomysium, or a combination of these. Recently, a novel serologic assay using deamidated gliadin-analogous fusion peptides (GAF3X) showed high diagnostic sensitivity in patients with CD.
  
  
  OBJECTIVE
  The aim of this study was to explore the anti-GAF3X enzyme-linked immunosorbent assay (ELISA) and to compare it with a panel of classic CD-related serologic tests in patients with DH.
  
  
  METHODS
  Antibodies against nGli, GAF3X, and tTG were determined by separate ELISA tests and against endomysium by indirect immunofluorescence microscopy in 45 patients with DH and 52 control patients (30 patients with bullous pemphigoid and 22 patients with linear IgA disease). A total of 24 patients with DH underwent intestinal biopsies to confirm underlying CD.
  
  
  RESULTS
  Antibodies to nGli were detected in 26 (58%) (IgA) and 24 (53%) (IgG), to GAF3X in 38 (84%) (IgA) and 36 (80%) (IgG), to tTG in 35 (78%) (IgA), and to endomysium in 32 (71%) (IgA) patients with DH. Combined testing of IgA and IgG antibodies to GAF3X detected 7 of 10 (70%) IgA-anti-tTG-negative patients with DH and together with the IgA-anti-tTG ELISA showed the highest serologic hit rate (93%) for CD.
  
  
  CONCLUSIONS
  Intestinal biopsies were not performed in all patients with DH.
  
  
  CONCLUSIONS
  The novel anti-GAF3X ELISA shows a higher sensitivity to detect CD-associated autoantibodies in patients with DH compared with tests using nGli, tTG, or endomysium as substrates.
authors.affiliation: Department of Dermatology, University of Lübeck, Lübeck, Germany. Michael.Kasperkiewicz@uk-sh.de
authors.forename: Michael
authors.initials: M
authors.lastname: Kasperkiewicz
authors.forename: Cornelia
authors.initials: C
authors.lastname: Dähnrich
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
authors.forename: Lars
authors.initials: L
authors.lastname: Komorowski
authors.forename: Winfried
authors.initials: W
authors.lastname: Stöcker
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schlumberger
authors.forename: Detlef
authors.initials: D
authors.lastname: Zillikens
authors.forename: Christian
authors.initials: C
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D003874:Dermatitis Herpetiformis / Q000097:blood* / Q000209:etiology; D005260:Female; D005903:Gliadin; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D010455:Peptides; D012698:Serologic Tests
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D010455:Peptides; D005903:Gliadin