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Subject:
From:
Roy Jamron <[log in to unmask]>
Reply To:
Roy Jamron <[log in to unmask]>
Date:
Wed, 30 Apr 2003 22:08:24 -0500
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<<Disclaimer: Verify this information before applying it to your situation.>>

This study suggests the human recombinant anti-tTG ELISA test may be the
better choice over an EMA test:

http://jcp.bmjjournals.com/cgi/content/abstract/56/5/389

Journal of Clinical Pathology 2003 May;56:389-393

The role of antitissue transglutaminase assay for the diagnosis and
monitoring of coeliac disease: a French-Italian multicentre study.

Tonutti E, Visentini D, Bizzaro N, Caradonna M, Cerni L, Villalta D,
Tozzoli R.

Istituto di Chimica Clinica, Azienda Ospedaliera S. Maria della
Misericordia, 33100 Udine, Italy Laboratorio di Patologia Clinica, Ospedale
Civile, 30027 S. Dona di Piave (VE), Italy Eurospital S.p.A., via Flavia
122, 34127 Trieste, Italy Servizio di Immunologia e Microbiologia, Azienda
Ospedaliera S. Maria degli Angeli, 33170 Pordenone, Italy Laboratorio di
Chimica Clinica e Microbiologia, Ospedale Civile, 33053 Latisana (UD),
Italy.

Aims: Tissue transglutaminase (tTG) was recently identified as the major
autoantigen in coeliac disease. The aim of this multicentre study was to
evaluate the impact of a new immunoenzymatic assay for the detection of IgA
anti-tGT antibodies.

Methods: Seventy four Italian and French clinical laboratories participated
in this study; anti-tTG IgA with an enzyme linked immunosorbent assay
(ELISA) method using guinea pig liver extract as the coating antigen, anti-
endomysium IgA autoantibodies (EMA), and total serum IgA were determined in
7948 patients, 1162 of whom had coeliac disease (737 untreated cases and
425 on a gluten free diet). A proportion of the sera were then sent to a
reference laboratory for anti-tTG retesting with an ELISA method using
recombinant human tTG antigen.

Results: Seven thousand four hundred and fifty eight (93.8%) sera were
EMA/antiguinea pig tTG concordant (positive or negative); 490 (6.2%) were
non-concordant. The sensitivity of EMA and antiguinea pig tTG in the 737
untreated patients with coeliac disease was 92.1% and 94.8%, respectively,
and the specificity was 99.8% and 99.2%, respectively. Retesting of the
discordant sera showed that of the 162 sera classified as EMA
negative/antiguinea pig tTG positive, only 49 were positive for human
recombinant anti-tTG, and that 39 of these were also EMA positive.
Furthermore, of the 36 sera classified as EMA positive/antiguinea pig tTG
negative, only two were confirmed as EMA positive.

Conclusions: The antiguinea pig tTG assay is more sensitive but less
specific than EMA, whereas the antihuman recombinant tTG assay is far more
specific and just as sensitive as antiguinea pig tTG. Testing for EMA
presents considerable interpretative problems and is difficult to
standardise.

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