Skip to main content
NCBI home page
Journal of Clinical Laboratory Analysis logoLink to Journal of Clinical Laboratory Analysis
. 2009 May 19;23(3):165–171. doi: 10.1002/jcla.20313

Diagnostic efficacy of the ELISA test for the detection of deamidated anti‐gliadin peptide antibodies in the diagnosis and monitoring of celiac disease

Elio Tonutti 1,✉, Daniela Visentini 1, Alessia Picierno 1, Nicola Bizzaro 2, Danilo Villalta 3, Renato Tozzoli 4, Graziano Kodermaz 4, Antonio Carroccio 5, Giuseppe Iacono 6, Saverio Teresi 7, Stella Maria La Chiusa 8, Ignazio Brusca 8
PMCID: PMC6649130  PMID: 19455636

Abstract

Background and Aim: We evaluated the diagnostic performance of an ELISA test for anti‐gliadin IgA and IgG antibodies, which uses synthetic deamidated gliadin peptides (anti‐gliadin antibodies, AGAs) as coating; the results were compared with a test that uses extracted gliadin (AGAe).

Methods: The study was conducted on the sera of 144 patients suffering from celiac disease (CD), including 20 patients with IgA deficiency and 9 who were following a gluten‐free diet (GFD), and 129 controls.

Results: In the 115 CD patients (without IgA deficiency), the sensitivity of AGAe IgA and IgG was 32.2 and 60.9%, whereas that of AGAs IgA and IgG was 59.1 and 72.2%. The specificity for AGAe IgA and IgG, and AGAs IgA and IgG was 93.8 and 89.9%, and 96.9% and 99.2%, respectively. Of the 20 patients with CD and IgA deficiency, 7 tested positive for AGAe IgG and 14 for AGAs IgG. The test using deamidated gliadin peptides performed better in terms of sensitivity and specificity than the AGA tests with extracted antigen.

Conclusions: The very high specificity of the AGAs IgG test (99.2%) also suggests that patients who test positive with this assay require a thorough followup, even if the anti‐tissue transglutaminase antibodies (anti‐tTG) and anti‐endomysial autoantibodies (EMA) assays are negative. J. Clin. Lab. Anal. 23:165–171, 2009. © 2009 Wiley‐Liss, Inc.

Keywords: celiac disease, deamidated gliadin peptides, anti‐gliadin antibodies, anti‐transglutaminase antibodies

REFERENCES

  • 1. Maki M, Collin P. Coeliac disease. Lancet 1997;349:1755–1759. [DOI] [PubMed] [Google Scholar]
  • 2. Koning F. Celiac disease: Caught between a rock and a hard place. Gastroenterology 2005;129:1294–1301. [DOI] [PubMed] [Google Scholar]
  • 3. Nilsen EM, Jahnsen FL, Lundin KE, et al. Gluten induces an intestinal cytochine response strongly dominated by interferon gamma in patients with celiac disease. Gastroenterology 1998;115:551–563. [DOI] [PubMed] [Google Scholar]
  • 4. Dieterich W, Ehins T, Bauer M, et al. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med 1997;3:797–801. [DOI] [PubMed] [Google Scholar]
  • 5. Sollid LM. Molecular basis of celiac disease. Ann Rev Immunol 2000;18:53–81. [DOI] [PubMed] [Google Scholar]
  • 6. Vidales MC, Zubillaga P, Zubillaga I, Alfonso‐Sanchez MA. Allele and haplotype frequencies for HLA class II (DQA1 and DQB1) loci in patients with celiac disease from Spain. Hum Immunol 2004;65:352–358. [DOI] [PubMed] [Google Scholar]
  • 7. Godkin A, Jewell D. The pathogenesis of celiac disease. Gastroenterology 1998;115:206–210. [DOI] [PubMed] [Google Scholar]
  • 8. van de Wal Y, Kooy Y, van Veelen P, et al. Cutting edge: Selective deamidation by tissue transglutaminase strongly enchanges gliadin‐specific T cell reactivity. J Immunol 1998;161:1585–1588. [PubMed] [Google Scholar]
  • 9. Marsh MN. Gluten, major histocompatibility complex and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992;102:330–354. [PubMed] [Google Scholar]
  • 10. Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillière's Clin Gastroenterol 1995;9:273–293. [DOI] [PubMed] [Google Scholar]
  • 11. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: Time for a standardized report scheme for pathologist. Eur J Gastroenterol Hepatol 1999;11:1185–1194. [DOI] [PubMed] [Google Scholar]
  • 12. Catassi C, Ratsch IM, Fabiani E, et al. Coeliac disease in the year 2000: exploring the iceberg. Lancet 1994; 343:200–203. [DOI] [PubMed] [Google Scholar]
  • 13. Ferguson A, Arranz E, O'Mahony S. Clinical and pathological spectrum of celiac disease. Gut 1993;34:150–151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Tonutti E, Visentini D, Bizzaro N, et al. The role of antitissue transglutaminase assay for the diagnosis and monitoring of celiac disease: A French–Italian multicentre study. J Clin Pathol 2003;56:389–393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Berger R, Schmidt G. Evaluation of six anti‐gliadin antibody assays. J Immunol Methods 1996;191:77–86. [DOI] [PubMed] [Google Scholar]
  • 16. Rostom A, Dubè C, Cranney A, et al. The diagnostic accuracy of serological test for celiac disease: A systematic review. Gastroenterology 2005;128:S38–S46. [DOI] [PubMed] [Google Scholar]
  • 17. Simell S, Kupila A, Hoppu S, et al. Natural history of transglutaminase autoantibodies and mucosal changes in children carrying HLA‐conferred celiac disease susceptibility. Scand J Gastroenterol 2005;40:1182–1191. [DOI] [PubMed] [Google Scholar]
  • 18. Aleanzi M, Demonte AM, Esper C, Garcilazo S, Waggener M. Celaic disease: antibody recognition against native and selectively deamidated gliadin peptides. Clin Chem 2001;47:2023–2028. [PubMed] [Google Scholar]
  • 19. Sugai E, Vazquez H, Nachman F, et al. Accuracy of testing for antibodies to synthetic gliadin‐peptides in celiac disease. Clin Gastroenterol Hepatol 2006;4:1112–1117. [DOI] [PubMed] [Google Scholar]
  • 20. Lock RJ, Gilmour JE, Unsworth DJ. Anti‐tissue transglutaminase, anti‐endomysium and anti‐R1‐reticulin autoantibodies: The antibody trinity of coeliac disease. Clin Exp Immunol 1999;116:258–262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Van Meensel B, Hiele M, Hoffman I, et al. Diagnostic accuracy of ten second‐generation (human) tissue transglutaminase antibody assay in celiac disease. Clin Chem 2004;50:2125–2135. [DOI] [PubMed] [Google Scholar]
  • 22. Catassi C, Fabiani E, Ratsc IM, et al. The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school‐age subjects. Acta Paediatr 1996; 412:29–35. [DOI] [PubMed] [Google Scholar]
  • 23. Volta U, Bellentani S, Bianchi FB, et al. High prevalence of coeliac disease in Italian general population. Dig Dis Sci 2001;46:1500–1505. [DOI] [PubMed] [Google Scholar]
  • 24. Catassi C, Ratsch IM, Gandolfi L, et al. Why is coeliac disease endemic in the people of the Sahara? Lancet 1999;354:647–648. [DOI] [PubMed] [Google Scholar]
  • 25. Lock RJ, Pitcher MCL, Unsworth DJ. IgA anti‐tissue transglutaminase as diagnostic marker of gluten sensitive enteropathy. J Clin Pathol 1999;52:274–277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Lenhardt A, Plebani A, Marchetti F, et al. Role of human‐tissue transglutaminase IgG and anti‐gliadin IgG antibodies in the diagnosis of coeliac disease in patients with selective immunoglobulin A deficiency. Dig Liver Dis 2004;36:730–734 [DOI] [PubMed] [Google Scholar]
  • 27. Hoffemberg EJ, Mac Kenzie T, et al. A prospective study of the incidence of childhood celiac disease. J Pediatr 2003;143:308–314. [DOI] [PubMed] [Google Scholar]
  • 28. Sjostrom H, Lundin KEA, Molberg O, et al. Identification of a gliadin T cell epitope in coeliac disease: General importance of gliadin deamidation for intestinal T recognition. Scand J Immunol 1998;48:111–115. [DOI] [PubMed] [Google Scholar]
  • 29. Arenz‐Hansen H, Komer R, Molberg O, et al. The intestinal T cell response to α‐gliadin in adult celiac disease is focused on a single deamidated glutamine targeted by tissue transglutaminase. J exp Med 2000;191:603–612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Cataldo F, Lio D, Marino V, Piccarelli A, Ventura A, Corazza GR. IgG(1) antiendomysium and IgG anti‐tissue transglutaminase (anti‐tTG) antibodies in coeliac patients with selective IgA deficiency. Working Groups on Celiac Disease of SIGEP and Club del Tenue. Gut 2000;47:366–369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Tursi A, Brandimante G, Giorgietti GM, et al. Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten free diet: A 2 years prospective study. Endoscopy 2006;38:702–707. [DOI] [PubMed] [Google Scholar]
  • 32. Schwertz E, Kahlenberg F, Sack U, et al. Serological assay based on gliadin‐related nonapeptides as a highly sensitive and specific diagnostic aid in celiac disease. Clin Chem 2004;50:2370–2375. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Laboratory Analysis are provided here courtesy of Wiley

RESOURCES