<<Disclaimer: Verify this information before applying it to your situation.>>

On November 21, 2002 I posted:

"Biopsies not needed???

With all the heat on biopsies lately, this Cuban/Spanish research article
is free at http://www.thelancet.com/ if you are registered with The
Lancet.  It suggests that there is an inexpensive accurate test to diagnose
celiac disease without a biopsy:

One-step immunochromatographic assay for screening of coeliac disease
Luis Sorell, Jose A Garrote, Boris Acevedo, Eduardo Arranz

Tissue transglutaminase is the autoantigen that elicits
endomysial antibodies, which are the serological hallmarks of
coeliac disease. We describe a simple, rapid immunochromato-graphic
assay for IgA and IgG antibodies to transglutaminase,
which is highly accurate for diagnosis of this disease. Results
were positive for all samples from 50 untreated coeliac
patients, and negative for 40 non-coeliac patients with
gastrointestinal disorders. The assay seems to be a useful
alternative to biopsy for mass screening for coeliac disease.

Lancet 2002; 359: 945-46 (March 16, 2002)"

Some people who responded to this post claimed to have been given this
test.  While they may have been given an ELISA test for transglutaminase
(tTG) IgA and IgG antibodies, it is extremely unlikely they were given this
particular test.  The test described above uses membrane test strips
fabricated by the researchers to identify the presence of the antibodies.
In a test that would take less than 10 minutes if performed in a doctor's
office, a strip is dipped in a sample of blood serum or plasma.  If 2
colored dots appear on the strip the test is positive.  If only 1 colored
dot appears, the test is negative.  The strips cost less than $1(US).
Simple, quick, fool-proof, accurate, and cheap.  To my knowledge, these
test strips are not yet commercially available for CD screening tests.

Current commercial CD screening tests include ELISA and immunofluorescence
tests for:

IgA antigliadin antibodies
IgG antigliadin antibodies
Transglutaminase IgA antibodies
Transglutaminase IgG antibodies
IgA endomysial antibodies
R1 antireticulin antibodies

Recently the endomysial and reticulin antigens were identified as being
tissue transglutaminase (tTG).  Hence the former endomysial and reticulin
tests have largely been replaced by tTG tests.

tTG tests currently may use either guineapig tTG or recombinant human tTG
to react with the antibodies in the blood sample.  Recent studies (see
references listed below) have compared test results using guineapig or
human tTG.  In general, recombinant human tTG produced more accurate
results.  The test strips described above use guineapig tTG.  The studies
suggest that the test strips could be made even more accurate than the
already high accuracy if recombinant human tTG were used instead.

The development of these quick, simple, and cheap test strips obviously
opens the door to the possibility of do-it-yourself home CD test kits.  A
home kit purchased at your local pharmacy might include test strips and a
lance.  Simply prick a finger with the lance.  Apply a drop of blood to the
end of the test strip.  And, voila!  Within 10 minutes, if 2 colored dots
appear on the strip, you're CD positive.  You could easily test your
children and other family members.  It would be extremely useful for
detecting the silent type CD that presents no symptoms.  All without a
doctor's appointment.

Some might be concerned that such home tests would discourage people from
visiting the doctor.  However, there are already a multitude of self-
diagnosed celiacs who simply choose to go on a GF diet on their own
initiative, including myself.  If a home test gives a positive CD result,
then one can still choose whether to followup with a doctor visit or obtain
a biopsy.  Commercial home CD test suppliers would have a very great
incentive to inform the general public about CD to promote sales of their
product.  This could only have a very positive affect on public celiac
disease awareness and reach many of those with the silent form of CD who
might, otherwise, never be diagnosed.

REFERENCES:

Recombinant human tissue transglutaminase for diagnosis and follow-up of
childhood coeliac disease.
Pediatr Res 2002 Jun;51(6):700-5
Hansson T; Dahlbom I; Rogberg S; Dannaeus A; Hopfl P; Gut H; Kraaz W;
Klareskog L
Department of Rheumatology, Karolinska Hospital, Stockholm, Sweden.

A comparison of 13 guinea pig and human anti-tissue transglutaminase
antibody ELISA kits.
J Clin Pathol 2002 Jul;55(7):488-94
Wong RC; Wilson RJ; Steele RH; Radford-Smith G; Adelstein S
Division of Immunology, Queensland Health Pathology Services, Princess
Alexandra and Royal Brisbane Hospitals, Australia.

Comparison of anti-transglutaminase ELISAs and an anti-endomysial antibody
assay in the diagnosis of celiac disease: a prospective study.
Clin Chem 2002 Sep;48(9):1546-50
Carroccio A; Vitale G; Di Prima L; Chifari N; Napoli S; La Russa C; Gulotta
G; Averna MR; Montalto G; Mansueto S; Notarbartolo A
First and Second Divisions of Internal Medicine, University Hospital of
Palermo, via Coffaro 25, 90127 Palermo, Italy.

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