SUITABILITY OF DETECTION OF
ANTIBODIES AGAINST BOTH TISSUE TRANSGLUTAMI-NASE (tTGA) AND ENDOMYSIUM
(IgAEmA) IN DIAGNOSING COELIAKIA IN CHILDREN WITH TYPE I DIABETES
J.
Brett-Chrusciel, J. Rujner, E. Piontek, H. Gregorek, B. Wozniewicz, G.
Wasaznik, A. Kus
Institute “Monument– Centre
Health Children’’, Warsaw, Poland
Objective: In type I diabetes (IDDM)
coeliakia (CD), particularly in its silent form, is more frequently
encountered than in general population. If glutenfree diet is not applied
in children with double diagnosis of IDDM and CD the metabolic correction
of diabetes is hampered. Hence the application of immunological tests,
enabling detection and treatment monitoring of CD is both appropriate and
important and presence of specific for coeliakia IgAEmA antibodies is
tested since several years. Tissue transglutaminase is considered an
autoantigen for endomysium. Presence of antibodies against endomysium
(tTGA) in serum of coeliakia patients was recently discovered. We decided
to attempt to find out correlation, if any, of occurrence of both
antibodies: IgAEmA and tTGA, in children with IDDM. The detection of tTGA
is cheaper.
Material and methods: In group I we included 18
children (age 5 to 19) with IDDM, two of which were previously diagnosed as
coeliakia. 21 antibodies tests were performed. 22 subjects of group II (age
5-23 years) had coeliakia, confirmed by biopsy of jejunum (bj) with 4-th
grade atrophy of intestinal villi. The control group consisted of 15
children (age 5-15 years) with shortage of height in whom to exclude
coeliakia bj was performed with negative result. CD is diagnosed on the
base of ESPGAN criteria. Both tTGA and IgAEmA were tested in the same serum
sample with ELISA method. Normal values are: <10 U/ml for tTGA, ELISA, and
<1:5 for IgAEmA, immunofluorimetric method.
Results: In the group I no IgAEmA
were detected in 17 children, including 2 children with CD diagnosed,
treated with glutenfree diet. tTGA was not detected in 15 children. In 1
child IgAEmA (>1:50) and tTGA (>270 U/ml) were found. In this child
bj performed for confirmation of diagnosis presented 4th grade
of jejunal villi atrophy. In control examination following 3 months
glutenfree diet treatment, a decrease of IgAEmA titre (1:20) and that of
tTGA (44 U/ml) was found. In another child with IDDM and CD treated with
glutenfree diet tTGA level was low (17 U/ml), and IgAEmA were absent. In
group II in all subjects IgAEmA were found (titre: 1:20 to 1:50) and tTGA
(20 to >270 U/ml). In controls neither tTGA nor IgAEmA were detected.
Conclusion: These
preliminary results indicate, that tTGA detection may serve as a screening
test in diagnosing and monitoring TCD in children with IDDM. It is cheaper
than IgAEmA testing.