Intestinal anti-transglutaminase2 IgA deposits in children at risk for coeliac disease: data from the Prevent CD study

Summary

In Coeliac Disease (CD) anti-tissue transglutaminase2 IgA antibodies(anti-TG2) are produced and deposited in the intestine. PreventCD (www.preventcd.com) is a European multicenter study, which studies the influence of infant nutrition, and that of genetic, immunologic and other environmental factors, on the risk of developing CD. The aim of the current study was to evaluate in very early intestinal biopsies from at-risk infants the appearance of intestinal anti-TG2 deposits and their predictive value for villous atrophy.

Sixty-five small bowel biopsies, performed in 62 children, were investigated for the presence of intestinal anti-TG2 extracellular IgA deposits by using double immunofluorescence. The biopsies were performed in the presence of elevated serum levels of CD–associated antibodies and/or symptoms suggesting disease. Deposits of anti-TG2 IgA were present in 53/53 CD patients and 3/3 potential CD. In potential CD patients mucosal deposits showed a patchy distribution characterized by some areas completely negative, whereas active CD patients had uniformly present and evident mucosal deposits. Only 1/6 patients without CD (negative for serum anti-TG2 and with normal mucosa) had intestinal deposits with a patchy distribution and a weak staining. Two of the 53 CD patients received definitive diagnosis of CD after a second or a third biopsy, in all samples mucosal deposits of anti-TG2 IgA were evaluated. Both patients, before developing villous atrophy, had anti-TG2 deposits in normal mucosal architecture, in one of them antibodies being absent in serum. We demonstrated that in CD the intestinal deposits of anti-TG2 are constant presence and appear very early in the natural history of disease. This article is protected by copyright. All rights reserved.