Usefulness of a double immunofluorescence technique for detection of intestinal tTG-IgA deposits in diabetic and non-diabetic children with celiac disease

• Published in: Pediatrics and neonatology Vol. 64; no. 4; pp. 388 - 397
• Main Authors: Lal, Raghav, Bhardwaj, Ranjeet, Minz, Ranjana Walker, Prasad, Kaushal Kishore, Lal, Sadhna, Dayal, Devi, Kumar, Yashwant
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01-07-2023; Elsevier
• Subjects: anti-tissue transglutaminase IgA antibody; Autoantibodies; celiac disease; Celiac Disease - complications; Celiac Disease - diagnosis; Child; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; double immunofluorescence; Fluorescent Antibody Technique; Humans; Immunoglobulin A - analysis; quantitative histology; Reproducibility of Results; tissue transglutaminase; Transglutaminases; type I diabetes Mellitus; anti-tissue transglutaminase IgA antibody; celiac disease; quantitative histology; double immunofluorescence; tissue transglutaminase; type I diabetes Mellitus
• ISSN: 1875-9572; 2212-1692
• DOI: 10.1016/j.pedneo.2022.01.012

Celiac disease (CD) is frequently associated with type I diabetes mellitus (T1D), where its diagnosis may be a challenging task. This study aims to test the usefulness of the double staining immunofluorescence (dsIF) technique for the detection of intestinal anti-tissue transglutaminase specific IgA antibody (tTG-IgA) deposits in CD and T1D children with coexisting CD.
A total of 46 patients (30 cases of CD and 16 cases of T1D with CD) and 16 non-diabetic, non-celiac children were recruited. Endoscopic biopsies were taken and analyzed by light microscopy, quantitative histology (QH), and a dsIF technique.
Histologically, villous atrophy was most severe in CD, followed by T1D with CD, while all control biopsies except 1 were normal. QH showed a statistically significant difference in villous height (Vh), crypt depth (CrD), and Vh:CrD ratio between diabetic and non-diabetic patients with CD. dsIF technique could detect tTG-IgA deposits in 85.7% of cases of CD alone and 93.8% of biopsies from diabetic children. Surprisingly, deposits were more extensive in biopsies with minimal villous shortening. Also, all 5 biopsies from T1D patients with normal histology were dsIF positive.
In-situ analysis of tTG-IgA immune deposits facilitates the detection of positive serology early-onset CD. Quantitative analysis may be used as an ancillary tool to increase the reliability of histological findings in these patients.