Celiac disease (CD) is an autoimmune inflammatory disorder that can occur in genetically predisposed patients where the ingestion of prolamins found in wheat, rye, oat or barley, leads to damage in the small intestine. The incidence is 1 percent and the prevalence of “suspected” CD varies from 1/87 to 1/500 individuals in western countries.
Since the epidemiology and phenotype of CD is constantly changing toward latent, hyposymptomatic or asymptomatic behavior, and since there is an increased risk of complications, early diagnosis and adherence to a gluten-free diet is highly recommended. It has been shown that the classic intestinal clinical picture of malnutrition, chronic diarrhea and nutritional deficiencies are disappearing and extra-intestinal presentations are emerging.
As indicated in the Iceberg Model of CD, the majority of cases are hyposymptomatic and therefore, the disease is under-diagnosed. Its recent incidence has increased due to environmental factors rather than genetic changes.1 Screening patients in high-risk groups could be beneficial, providing a good cost-benefit compromise.2
Currently, one of the most common assays for CD is the measurement of anti-tTG (anti-tissue transglutaminase) autoantibodies of IgA isotype. Often, this assay is supplemented with measuring anti-tTG of IgG isotype in the presence of IgA deficiency (2-3 percent of celiac patients suffer from IgA deficiency).
Unfortunately, a test with 100 percent sensitivity and specificity does not exist. However, it is possible to offer a combination of tests that optimize the cost and performance balance. The objective is to favor a sensitive and accurate solution for screening while providing higher specificity in absence of clinical evidence. A popular combined solution is the detection of IgA anti-tTG, associated with anti endomysial antibodies.
Recent studies show that the use of a new antigen (Neo-epitope tTG) can contribute to an early and accurate diagnosis of CD.3
Figure 1 illustrates autoantibodies that can be detected with the Neo-epitope. AESKU.DIAGNOSTICS offers a new generation of products (CeliCheck) with this Neo-epitope, used to screen for IgA and/or IgG isotypes.4
The Neo-epitope offers a combination test imitating the celiac intestinal events, where gliadin is linked to tTg and deamidated by the enzyme. Studies have shown earlier detection of anti-neo-epitope antibody. It represents a new approach to screening of at-risk patients, and an excellent compromise in terms of performance (sensitivity and specificity) and reliability.5
For more information come see AESKU’s poster:
Poster Session: 05. Immunology
Tues., July 28, 9:30 a.m.-5 p.m.
AESKU.DIAGNOSTICS
www.aesku.com
Phone: 877-753-6240
Booth #2745
1. Lerner A. “Factors affecting the clinical presentation and time diagnosis of celiac disease: The Jerusalem and the West Bank-Gaza experience”. Israel Journal of Medical Sciences 11 (1994): 294-295.
2. Lerner A. Serological Diagnosis of Celiac Disease –Moving Beyond the Tip of the Iceberg. International Journal of Celiac Disease. Editorial. 2014; 2:64-66.
3. Matthias, T., et al. “Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope”. Clinical Reviews in Allergy & Immunology 38 (2010):298-301.
4. Tozzoli, R., et al. “Detection of autoantibodies specific for transglutaminase-gliadin peptides complex: a new way to explore the celiac iceberg”. Italy Journal of Laboratory Medicine 6 (2010): 28-35.
5. Rozenberg, O., et al. “A novel algorithm for childhood celiac disease serological diagnosis based upon intestinal biopsies”. Clinical Reviews in Allergy & Immunology 11 (2012):331-341.