Comparative Evaluation of Serologic Tests for Celiac Disease Diagnosis and Follow-Up

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Abstract
Anti-endomysium antibody (EmA) testing is used in the diagnosis of celiac disease (CD). The identification (1) of tissue transglutaminase (tTG) as the main antigen of EmA led to the development of commercial ELISAs for serum anti-tTG detection. At first, a guinea pig antigen (2)(3)(4)(5)(6)(7) yielded both sensitivity and specificity lower than those of EmA; therefore, human recombinant tTG (8)(9)(10)(11) was introduced to improve diagnostic accuracy and to overcome problems such as species specificity and cross-reactivity to contaminant proteins. However, the standardization of assays (12), the choice of cutoff value, the clinical relevance of these autoantibodies (13)(14), and the diagnostic accuracy of different commercial tests remain unresolved (15)(16)(17)(18). This study aimed to assess the diagnostic accuracy of five commercially available IgA anti-tTG ELISA reagent sets (four using a human recombinant and one a guinea-pig tTG antigen) for pathologically confirmed CD and to evaluate the changes in anti-tTG autoantibody concentrations during treatment of CD with a gluten-free diet (GFD).

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