Preprint Brief Report Version 1 Preserved in Portico This version is not peer-reviewed

Dynamics of Serologic Change to Gluten in Celiac Disease Patients

Jack Syage
* ORCID logo ,
Ana Ramos
,
Vasiliy Loskutov
,
Anna Norum
,
Adam C Bledsoe
,
Rok Seon Seon Choung
,
Matthew Dickason
,
Jennifer Sealey-Voyksner
,
Joseph Murray
Version 1 : Received: 23 October 2023 / Approved: 1 November 2023 / Online: 2 November 2023 (07:56:27 CET)

A peer-reviewed article of this Preprint also exists.

Syage, J.; Ramos, A.; Loskutov, V.; Norum, A.; Bledsoe, A.; Choung, R.S.; Dickason, M.; Sealey-Voyksner, J.; Murray, J. Dynamics of Serologic Change to Gluten in Celiac Disease Patients. Nutrients 2023, 15, 5083. Syage, J.; Ramos, A.; Loskutov, V.; Norum, A.; Bledsoe, A.; Choung, R.S.; Dickason, M.; Sealey-Voyksner, J.; Murray, J. Dynamics of Serologic Change to Gluten in Celiac Disease Patients. Nutrients 2023, 15, 5083.

Abstract

Serologic measures of tissue transglutaminase (tTG) immunoglobulin A (IgA) and deamidated gliadin peptide (DGP) IgA and immunoglobulin G (IgG) are hallmark tests utilized when diagnosing individuals for celiac disease (CeD) and for monitoring adherence to a gluten-free diet (GFD), currently the only available treatment for CeD. We address two issues in this study: (i) the relapse to seropositivity for CeD patients who resume a gluten containing diet and (ii) the correlation between two different tTG-IgA assays near the upper limit of normal (ULN) designated thresholds. Regarding the first issue, often a suspected CeD individual is put back on a gluten diet to return to their serologic levels. However, we show it requires a substantial amount of gluten for serology to return to a positive level. For example, in one study of 22 patients treated with placebo and taking 84 g of gluten over 6 weeks, only 2 converted from seronegative to seroposi-tive for tTG-IgA. Regarding the second topic, we compare the relationship for different serologic assays, namely tTG-IgA AB (recombinant, ULN=4 Units/mL) vs. tTG-IgA (non-recombinant, ULN=20 Units). There is a strong correlation by both measurements as evidenced by a Pearson coefficient of R = 0.8584. However, we observed that the cross-correlation in terms of sensitivity and specificity improved substantially by using an ULN value of 3 instead of 4 for the tTG-IgA AB (recombinant) assay. This result suggests that assay thresholds used for initial diagnosis in patients who have not yet started a GFD may need to be adjusted for monitoring and in the setting of a diagnostic gluten challenge.

Keywords

celiac disease; serology; gluten; gluten-free diet (GFD); tTG-IgA

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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