Anti-transglutaminase antibodies
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Anti-transglutaminase antibodies
Anti-transglutaminase Antibodies
Anti-transglutaminase antibodies are a group of autoantibodies that target the enzyme tissue transglutaminase (tTG). These antibodies are primarily associated with celiac disease, an autoimmune disorder that affects the small intestine in genetically predisposed individuals.
Function
Tissue transglutaminase is an enzyme that plays a crucial role in the modification of proteins by catalyzing the formation of covalent bonds between glutamine and lysine residues. This process is important for the stabilization of the extracellular matrix and the repair of damaged tissues. In individuals with celiac disease, the ingestion of gluten, a protein found in wheat, barley, and rye, leads to an immune response that results in the production of anti-transglutaminase antibodies.
Clinical Significance
The presence of anti-transglutaminase antibodies is a key marker for the diagnosis of celiac disease. These antibodies are highly specific and sensitive for the condition, making them an essential component of the diagnostic process. The detection of these antibodies is typically performed using serological tests, such as the enzyme-linked immunosorbent assay (ELISA).
In addition to their role in celiac disease, anti-transglutaminase antibodies may also be present in other autoimmune conditions, although they are less commonly associated with these disorders. The levels of these antibodies often correlate with the degree of intestinal damage and can be used to monitor the response to a gluten-free diet.
Pathophysiology
The pathogenesis of celiac disease involves a complex interplay between genetic, environmental, and immunological factors. The ingestion of gluten leads to the deamidation of gluten peptides by tissue transglutaminase, which enhances their immunogenicity. These modified peptides are then presented by HLA-DQ2 or HLA-DQ8 molecules on antigen-presenting cells, triggering an immune response that results in the production of anti-transglutaminase antibodies and the destruction of the intestinal villi.
Diagnosis
The diagnosis of celiac disease involves a combination of serological testing for anti-transglutaminase antibodies and histological examination of a small intestine biopsy. The presence of these antibodies, along with characteristic histological findings such as villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes, confirms the diagnosis.
Treatment
The primary treatment for celiac disease is a strict gluten-free diet, which leads to the resolution of symptoms and normalization of antibody levels in most patients. Regular monitoring of anti-transglutaminase antibody levels can help assess adherence to the diet and the effectiveness of the treatment.
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Contributors: Prab R. Tumpati, MD