Annals of Clinical Biochemistry > Volume 43, Number 2 > Pp. 105-117

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Review Articles

Anti-tissue transglutaminase antibodies and their role in the investigation of coeliac disease

PG Hill and SA McMillan

Department of Chemical Pathology, Haematology and Immunology, Derbyshire Royal Infirmary, Derby Hospitals NHS Foundation Trust, Derby DE1 2QY; Regional Immunology Service, Kelvin Laboratories, Royal Group of Hospitals, Belfast BT12 6BN, UK

Coeliac disease (CD), caused by an inappropriate T-cell-mediated immune response to the ingestion of cereal proteins in genetically susceptible individuals, is a common disorder with a prevalence of about 1% in Caucasian populations. It has a strong association with other autoimmune disorders, particularly type 1 diabetes and autoimmune thyroid disease. Although primarily affecting the small bowel, CD is a multisystem disorder and the adult or child patient may initially present to a wide range of clinical specialities. The concept of the 'coeliac iceberg' has been used to emphasize that many cases currently remain undiagnosed. The identification of tissue transglutaminase (TGA)-2 as the antigen against which the autoantibodies are directed has led to a greater understanding of the pathogenesis of CD and to the development of improved serological tests. Enzyme-linked immunoassays using human tissue TGA as antigen have high diagnostic sensitivity and specificity for the detection of CD. This review examines the evidence for adopting IgA anti-tissue TGA as the first-line diagnostic test for CD. It recommends a laboratory algorithm for the use and interpretation of TGA to enable the clinical laboratory to play a full part in detecting and monitoring a disorder that is eminently treatable once the diagnosis has been considered and confirmed.

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