Small-bowel mucosal transglutaminase 2-specific IgA deposits in coeliac disease without villous atrophy: A prospective and randomized clinical study

Kaukinen, Katri and Peraaho, Markku and Collin, Pekka and Partanen, Jukka and Woolley, Nina and Kaartinen, Tanja and Nuutinen, Tuula and Halttunen, Tuula and Mäki, Markku and Korponay-Szabó, Ilma Rita (2005) Small-bowel mucosal transglutaminase 2-specific IgA deposits in coeliac disease without villous atrophy: A prospective and randomized clinical study. Scandinavian Journal of Gastroenterology, 40 (5). pp. 564-572. ISSN 0036-5521 (print), 1502-7708 (online)

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Abstract

Objective. In coeliac disease, autoantibodies directed against transglutaminase 2 are produced in small-bowel mucosa, and they have been found to be deposited extracellularly. The aim of this study was to investigate whether such mucosal IgA deposits are important in the diagnostic work-up of early-stage coeliac disease without small-bowel mucosal villous atrophy. Material and methods. Forty-one adults suspected of coeliac disease owing to increased density of mucosal gamma delta + intraepithelial lymphocytes but normal villous morphology were randomized to gluten challenge or a gluten-free diet for 6 months. Clinically and histologically verified gluten dependency was compared with existence of small-bowel mucosal transglutaminase 2-specific extracellular IgA deposits and ( coeliac disease-type) HLADQ2 and DQ8; 34 non-coeliac subjects and 18 patients with classical coeliac disease served as controls. Results. Of the 41 patients, 5 in the challenge group and 6 in the gluten-free diet group were clinically gluten sensitive; all 11 had HLA DQ2 or DQ8. Ten of these 11 patients showed transglutaminase 2-targeted mucosal IgA deposits, which were dependent on gluten consumption. Minimal IgA deposits were seen in only 3 out of 30 patients with suspected coeliac disease without any clinically detected gluten dependency. The deposits were found in all classical coeliac patients and in none of the non-coeliac control subjects. Conclusions. Clinically pertinent coeliac disease exists despite normal small-bowel mucosal villous architecture. Mucosal transglutaminase 2-specific IgA deposits can be utilized in detecting such patients with genetic gluten intolerance.

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