Gluten-sensitive enteropathy or celiac disease is characterized by atrophy of the small intestinal villi leading to a so called flat mucosa. It is caused by a pathological intolerance to Gliadin, the alcohol – soluble fraction of gluten in wheat, rye and barley. As celiac disease is caused by the intake of gluten, consequently gluten – free diet cures the disease completely and thus has to be maintained throughout life, renewed consumption of Gliadin leads to a return of the symptoms. The disease is HLA – associated (>95% of patients have DQ2 encoded by DQA1*0501 and DQB1*0201) and inanifests at any age with a peak onset in early childhood, even in newborn babies. The incidence ranges from 1 in 4000 to 1 in 300 in European countries. Diagnosis of celiac disease is made by small intestinal biopsy (demonstrating the flat mucosa) supported by serological markers. Antibodies against Gliadin and anti – endomysium antibodies (EMA) are of major significance. They are detected so far by indirect immunofluorescence (IFT), which is restricted to subclass IGA only. The identification of tissue transglutaminase (Ttg) as a major target antigen of EMA provided the opportunity of an easier and more reliable diagnosis of celiac disease. Ttg is an enzyme that upon tissue damage is released from the cells where it is thought to aid in tissue repair.

Anti – TtG antibodies show higher sensitivity and specificity than anti – Gliadin antibodies. Furthermore, they closely correlate with the activity of the disease and thus are especially useful for diet monitoring. The cross – link of TtG with gliadin – specific peptides results in neo – epitopes of TtG. As these neo – epitopes are structurally closer to the physiological antigens; this new generation test shows a markedly increased sensitivity and specificity. These epitopes show no cross – reactivities with gliadin. The determination of IgG antibodies to Ttg is the only available specific serology for that 2-5% of patient with Iga deficiency. A high number of subclinical cases have been detected by screening for anti – Ttg, fostering the theory that the majority of celiac disease cases goes undetected and untreated (Iceberg model).

• Specimen Serum
• Preformed Daily
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