title: Beyond the Intestinal Celiac Mucosa: Diagnostic Role of Anti-TG2 Deposits, a Systematic Review.
abstract: OBJECTIVE
  To review the existing literature on the role and significance of intestinal transglutaminase 2 immunoglobulin A deposits (TG2 deposits) in patients with overt celiac disease (CD), potential celiac disease (PCD), and other autoimmune or gluten-related conditions.
  
  
  METHODS
  We conducted a systematic review of studies published in English, evaluating presence and characteristics of TG2 deposits in subjects with overt CD, PCD, gluten-related diseases [dermatitis herpetiformis (DH), gluten-ataxia (GA)], autoimmune disorders (type-1 diabetes), and other conditions. Studies were identified through a MEDLINE search (1950-2013).
  
  
  RESULTS
  Twenty-three studies were included in the review. Eleven studies were performed in children. Overall TG2 deposits were present in 100% of adults with overt CD, while in children prevalence ranged from 73.2 to 100%. Six studies with an established definition of PCD were considered, prevalence of deposits ranging from 64.7 to 100%. A single study followed-up PCD patients with repeated biopsies and identified presence of intestinal deposits as the best marker to reveal progression toward villous atrophy. Two studies investigated presence of deposits in DH, reporting prevalence between 63 and 79%. A single study documented TG2 deposits in 100% of patients with GA. In children with type-1 diabetes (T1D), positivity of intestinal TG2 deposits ranged from 25 to 78%.
  
  
  CONCLUSIONS
  Transglutaminase 2 IgA deposits seem to be a constant feature in overt CD patients and are frequently detectable in other gluten-related conditions (DH and GA). The vast majority of PCD patients express TG2 deposits at the intestinal level, but no sufficient data are available to exactly define their prognostic role as a marker of evolution toward overt CD. The frequent finding of TG2 deposits in the intestinal mucosa of patients with T1D is an interesting observation deserving further evaluation.
authors.affiliation: Department of Pediatrics, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Gatti
authors.affiliation: Department of Pediatrics, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Department of Surgical Pathology, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Alfonsi
authors.affiliation: Department of Surgical Pathology, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mandolesi
authors.affiliation: Department of Pediatric Surgery, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cobellis
authors.affiliation: Department of Pediatrics, Università Politecnica delle Marche , Ancona , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
keywords: anti-tissue transglutaminase 2; celiac disease; dermatitis herpetiformis; immunofluorescence; intestinal deposits; potential celiac disease