Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population
BackgroundCeliac serology has evolved, with the identification of newer antibodies against deamidated gliadin peptides (DGP) [e.g., anti-DGP, immunoglobulin A (IgA), and immunoglobulin G (IgG) types] with sensitivity and specificity in detecting celiac disease (CeD) that are equivalent to anti-tissu...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1279825/full |
| _version_ | 1797489246179688448 |
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| author | Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdullah Al-Jurayyan Sahar Alharbi Muhammed Salman Bashir Riccardo Troncone |
| author_facet | Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdullah Al-Jurayyan Sahar Alharbi Muhammed Salman Bashir Riccardo Troncone |
| author_sort | Abdulrahman Al-Hussaini |
| collection | DOAJ |
| description | BackgroundCeliac serology has evolved, with the identification of newer antibodies against deamidated gliadin peptides (DGP) [e.g., anti-DGP, immunoglobulin A (IgA), and immunoglobulin G (IgG) types] with sensitivity and specificity in detecting celiac disease (CeD) that are equivalent to anti-tissue transglutaminase [anti-tissue transglutaminase (TTG) IgA]-based tests, particularly in populations with high pretest probability of CeD (prevalence of CeD > 50% of the population under study). This opens the possibility that anti-DGP assays can be used to identify CeD in the general population where the prevalence of CeD is very low (≈1%).ObjectiveThis study aimed (1) to determine the diagnostic performance of DGP antibodies-based serologic assays in identifying CeD during the screening of the general population and (2) to compare the levels of anti-DGP antibodies among CeD patients with mild and severe degrees of enteropathy.MethodsSerology tests for DGP antibodies (DGP-IgA, DGP-IgG, and conjugate TTG/DGP antibodies) were performed on 104 serum samples of positive TTG-IgA (100 confirmed and four potential celiac patients) and a randomly selected 1,000 negative TTG-IgA serum samples collected during mass screening of children (aged 6–15 years) in 2014–2015.ResultsSera from 32 of the 1,000 TTG-IgA negative serum specimens (3.2%) tested positive for one or more of the three anti-DGP serology tests. A total of 13 of the 32 anti-DGP seropositive patients had persistent positive results on follow-up samples in 2020 (1.3%). Eight of the 13 underwent endoscopy with biopsies, and only two had confirmed CeD (both DGP-IgG positive) (0.2%). The sensitivity and specificity of the serology assays were as follows: DGP-IgA (62.7%, 40%), DGP-IgG (80.4%, 100%), and conjugate TTG/DGP (96%, 10%). Based on receiver operating characteristic curves, the area under the curve for DGP-IgG (0.919; 95% CI −0.00406 to 0.114) was comparable to TTG-IgA (0.974; 95% CI 0.924–0.995) (P = 0.0679). Titers of antibodies to DGPs were significantly higher in children with severe intestinal damage than in those in children with mild lesions (P < 0.001).ConclusionThe TTG-IgA assay remains the most reliable screening serology test for CeD in mass screening studies. The performance of TTG-IgA has improved marginally by adding DGP-IgG to the mass screening protocol. In CeD patients detected by mass screening, the anti-DGP antibody titer was significantly higher among patients with a severe degree of enteropathy as compared to the group with mild enteropathy. |
| first_indexed | 2024-03-10T00:13:46Z |
| format | Article |
| id | doaj.art-2aa2df7731644907b1efa9d7dcdbf37a |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-10T00:13:46Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-2aa2df7731644907b1efa9d7dcdbf37a2023-11-23T15:53:52ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-11-011110.3389/fped.2023.12798251279825Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric populationAbdulrahman Al-Hussaini0Abdulrahman Al-Hussaini1Abdulrahman Al-Hussaini2Abdullah Al-Jurayyan3Sahar Alharbi4Muhammed Salman Bashir5Riccardo Troncone6Division of Pediatric Gastroenterology, Children’s Specialized Hospital, Riyadh, Saudi ArabiaCollege of Medicine, Alfaisal University, Riyadh, Saudi ArabiaPrince Abdullah Bin Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi ArabiaThe Department of Pathology and Clinical Laboratory Medicine, Immunology, Serology & HLA Laboratory Section, King Fahad Medical City, Riyadh, Saudi ArabiaThe Department of Pathology and Clinical Laboratory Medicine, Immunology, Serology & HLA Laboratory Section, King Fahad Medical City, Riyadh, Saudi ArabiaDepartment of Biostatistics, Research Services Administration, Research Center at King Fahad Medical City, Riyadh, Saudi ArabiaDepartment of Medical Translational Sciences & European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, Naples, ItalyBackgroundCeliac serology has evolved, with the identification of newer antibodies against deamidated gliadin peptides (DGP) [e.g., anti-DGP, immunoglobulin A (IgA), and immunoglobulin G (IgG) types] with sensitivity and specificity in detecting celiac disease (CeD) that are equivalent to anti-tissue transglutaminase [anti-tissue transglutaminase (TTG) IgA]-based tests, particularly in populations with high pretest probability of CeD (prevalence of CeD > 50% of the population under study). This opens the possibility that anti-DGP assays can be used to identify CeD in the general population where the prevalence of CeD is very low (≈1%).ObjectiveThis study aimed (1) to determine the diagnostic performance of DGP antibodies-based serologic assays in identifying CeD during the screening of the general population and (2) to compare the levels of anti-DGP antibodies among CeD patients with mild and severe degrees of enteropathy.MethodsSerology tests for DGP antibodies (DGP-IgA, DGP-IgG, and conjugate TTG/DGP antibodies) were performed on 104 serum samples of positive TTG-IgA (100 confirmed and four potential celiac patients) and a randomly selected 1,000 negative TTG-IgA serum samples collected during mass screening of children (aged 6–15 years) in 2014–2015.ResultsSera from 32 of the 1,000 TTG-IgA negative serum specimens (3.2%) tested positive for one or more of the three anti-DGP serology tests. A total of 13 of the 32 anti-DGP seropositive patients had persistent positive results on follow-up samples in 2020 (1.3%). Eight of the 13 underwent endoscopy with biopsies, and only two had confirmed CeD (both DGP-IgG positive) (0.2%). The sensitivity and specificity of the serology assays were as follows: DGP-IgA (62.7%, 40%), DGP-IgG (80.4%, 100%), and conjugate TTG/DGP (96%, 10%). Based on receiver operating characteristic curves, the area under the curve for DGP-IgG (0.919; 95% CI −0.00406 to 0.114) was comparable to TTG-IgA (0.974; 95% CI 0.924–0.995) (P = 0.0679). Titers of antibodies to DGPs were significantly higher in children with severe intestinal damage than in those in children with mild lesions (P < 0.001).ConclusionThe TTG-IgA assay remains the most reliable screening serology test for CeD in mass screening studies. The performance of TTG-IgA has improved marginally by adding DGP-IgG to the mass screening protocol. In CeD patients detected by mass screening, the anti-DGP antibody titer was significantly higher among patients with a severe degree of enteropathy as compared to the group with mild enteropathy.https://www.frontiersin.org/articles/10.3389/fped.2023.1279825/fullceliac diseasedeamidated gliadin peptidestissue transglutaminasemass screeningSaudi Arabia |
| spellingShingle | Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdulrahman Al-Hussaini Abdullah Al-Jurayyan Sahar Alharbi Muhammed Salman Bashir Riccardo Troncone Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population Frontiers in Pediatrics celiac disease deamidated gliadin peptides tissue transglutaminase mass screening Saudi Arabia |
| title | Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| title_full | Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| title_fullStr | Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| title_full_unstemmed | Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| title_short | Performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| title_sort | performance of deamidated gliadin peptide antibodies as first screening for celiac disease in the general pediatric population |
| topic | celiac disease deamidated gliadin peptides tissue transglutaminase mass screening Saudi Arabia |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1279825/full |
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