Autoimmunity

Due to a low diagnostic rate, changes in phenotype, increased incidence, epidemiological shift s and importance of early implementation of a gluten-free diet to prevent complications, a reliable serological marker for celiac disease (CD) is highly needed. Furthermore, the new 2012 ESPGHAN guidelines for the pediatric diagnosis of CD unraveled and stimulated an old/new discussion on the most effi cient bio-marker to screen/diagnose the disease. Th e plethora of the antibodies is wide, encompassing anti-gliadin (AGA), anti-endomysial (EMA), anti-deamidated gliadin peptide (DGP), anti-tissue transglutaminase (tTg), anti-tTg neo-epitope (tTg-neo), and most recently, the anti-microbial transglutaminase neo-epitope (mTg-neo) antibodies. Th e AGA are anti-nutrient antibodies and are not reliable for CD diagnosis. EMA is very specific. IgAtTg is the most frequently used, recommended by ESPGHAN but has multiple false +- results. IgA-DGP has unacceptable sensitivity. In recent years the IgA-tTg-neo (against the cross-linked complex of tTg and gliadin) appeared to be a very reliable marker for CD3. Checking 17 serological markers, the IgA-tTg-neo and IgG-mTg-neo stood out as very reliable diagnostic markers, refl ecting intestinal damage in CD3. Th e mTg-neo (against the cross-linked complex of mTg and gliadin) is a new biomarker for the CD. At the end of the day, the IgA-tTg-neo has the potential to win the race of the best diagnostic autoantibody for CD. Th e IgG-mTg-neo is a new marker against an environmental microbial product that is heavily used in the food processing industry. Th e possibility that mTg represents a potential environmental inducer of CD is currently investigated.