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Anti-transglutaminase antibodies – a marker for celiac disease – can be temporarily elevated in non-celiac children due to infection

A new study conducted by Italian researchers reveals that anti-transglutaminase antibodies can be produced temporarily as the outcome of an infectious disease, independently of gluten ingestion.

Celiac disease is a permanent intolerance to gluten in genetically predisposed individuals. For these patients, gluten cause an inflammation in the small intestine leading to tissue damage, hence requiring the complete and permanent elimination of gluten from the diet. The diagnosis of celiac disease is based on a combination of clinical, histological and serologic data. Among the latter, anti-transglutaminase antibodies are currently considered one of the most specific serologic markers for the diagnosis of the disease.

Now a new study suggests that anti-transglutaminase antibodies can be also temporarily elevated in non-celiac children as the outcome of an infectious process.

The researchers collected serum samples from 222 children with infectious diseases to test for the presence of anti-transglutaminase or anti-endomysium antibodies, two standard serologic markers of celiac disease. Those children who tested positive for one or both of these antibodies were then tested for the genetic markers for celiac disease (HLA DQ2 and DQ8, believed to be necessary for celiac disease to develop) and for antibodies to the following infectious pathogens: Epstein–Barr virus, rotavirus, adenovirus, echovirus and Coxsackievirus. The researchers also analysed the results of anti-transglutaminase tests in 1276 healthy children.

Nine of the 222 infected children (4%) tested positive to anti-transglutaminase. Of these, only one was positive for the genetic markers of celiac disease. For the remaining 8 children, levels of anti-transglutaminase and viral antibodies returned to normal after one year, despite a gluten-containing diet. The prevalence of the elevated levels of anti-transglutaminase antibodies among the infected children was also significantly higher than in the healthy children analyzed (8 positives out of 222 infected children as compared to 11 positives out of 1276 healthy children).

The study also found that the anti-transglutaminase antibodies triggered by the infection in non-celiac children had the same biological properties as the anti-transglutaminase antibodies observed in celiacs, namely, had the same potential for damage.

The researchers conclude the study by suggesting that elevated levels of anti-transglutaminase are not exclusive to celiac disease, but can represent an immunological phenomenon depending on yet-to-be identified triggers (in the case of the study, a viral infection) – a finding health professionals should be aware of when determining whether a patient is likely to have celiac disease or not.

Source:

Ferrara F, Quaglia S, Caputo I, Esposito C, Lepretti M, Pastore S, Giorgi R, Martelossi S, Dal Molin G, Di Toro N, Ventura A, Not T. 2009. Anti-transglutaminase antibodies in non-coeliac children suffering from infectious diseases. Clin Exp Immunol. Nov 12. [Epub ahead of print]