Transglutaminase Question.

[JerryK]

The way I'm understanding my Enterolab test results is....

Antigliadin IgA positive means that I likely have Gluten Sensitivity.

Antitissue Transglutaminase IgA positive means that an autoimmune reaction is

happening, which would be more indicative of actual intestinal damage/Celiac Disease.

Is my interpretation correct? Thanks! Jerry

[tarnalberry]

*Theoretically* I would agree with you. The "true" indication of damage to the intestine is through the biopsy, but I have a feeling medical science will change it's mind on that one eventually.

[JerryK]

*Theoretically* I would agree with you. The "true" indication of damage to the intestine is through the biopsy, but I have a feeling medical science will change it's mind on that one eventually.

Right, but they are testing for Transglutaminase because when that is positive it could be indication of

an autoimmune attack against your intestines..correct? Personally, I think if you get sick, that's an indication of damage:)

I just want to understand the meaning of the Transglutaminase test....

[CMCM]

Jerry, I had the full Enterolab panel AND the gene test. My results were interesting....a celiac gene, a gluten sensitivity gene, the transglutaminase score was 19, which indicated autoimmune activity, but my malabsorption score was 67, entirely normal. I also showed a score that was indicative of casein sensitivity as well. I asked a LOT of questions, and here are some of Dr. Fine's answers:

Now, there are several reasons why your results could have come out the way they did. You may only be manifesting the gluten sensitive gene and the Celiac gene is not at this point (which can always happen, so be prepared), or you could have had a higher malabsorption score prior to going gluten/casein-free and it has come down considerably on the diet, or it could be that your malabsorption score was never above the normal range and, as you said, you just don't have active or "full blown" Celiac Disease at this point. Please know that casein sensitivity can cause the same type of intestinal damage that gluten sensitivity can.

HERE ARE MORE OF MY QUESTIONS, FOLLOWED BY DR. FINE's ANSWERS:

Could you answer a couple of questions....

1. If you tested with only gluten sensitive genes (for example the 0604), would you be advised to NOT eat gluten even in the absence of symptoms?

2. Is it correct that if you have only gluten sensitive genes you would NEVER get celiac diease, although you could still have digestive symptoms?

3. If you have gluten sensitive genes only (and no celiac gene), then despite digestive symptoms you would not ever incur any intestinal damage?

4. I tested with one celiac gene and one gluten sensitive gene, and no evidence of malabsorption in the stool test. Can I make any of these assumptions below?

a. I definitely have symptoms going on, but since no malabsorption showed I may not have celiac disease at this time, only symptoms of gluten sensitivity?

b. Since I have had digestive symptoms for many years, I could have celiac disease going on but not bad enough to show in a stool sample, perhaps not even on a biopsy?

5. Casein sensitivity: I tested positive for this, and have always felt dairy was a problem. Does casein cause the same intestinal damage as gluten, and can continuing to

eat it also lead to other autoimmune reactions?

ANSWERS....

1) If you are a-symptomatic but have the genes, the choice will be yours as to whether or not you adopt a gluten-free diet. You must just know that gluten sensitivity can be triggered at any time in a person's life, so it is wise to know that gluten can always be a potential problem.

2) We do know that approximately 1% of Celiacs have a a gene different from the 2 main Celiac genes, but research just has not pinpointed the gene or gene combination for that 1% yet. So, it is entirely possible to have Celiac Disease without one of the two main genes. It is also possible to have positive results on your tests and malabsorption and not have at least one of the main Celiac genes, but having the genes increases the possibility of malabsorption and intestinal damage.

3) I believe I just covered this one, but you actually can have malabsorption even if you only have gluten sensitive genes. It is just less likely.

4) Either A or B could be correct in your case. I went into further detail on this in my other email.

5) We do know that casein sensitivity can cause the same type of intestinal damage as gluten, but we do not know that it triggers autoimmune reactions. Rashes, however, can definitely be caused by a casein sensitivity.

I don't know if any of this helps....

[tarnalberry]

Right, but they are testing for Transglutaminase because when that is positive it could be indication of

an autoimmune attack against your intestines..correct? Personally, I think if you get sick, that's an indication of damage:)

I just want to understand the meaning of the Transglutaminase test....

Yep, that's the test for antibodies against your own body. They don't rely on symptoms alone because the symptoms can be caused by something else, and some people don't display symptoms. It's horridly non-straightforward.

[JerryK]

Jerry, I had the full Enterolab panel AND the gene test. My results were interesting....a celiac gene, a gluten sensitivity gene, the transglutaminase score was 19, which indicated autoimmune activity, but my malabsorption score was 67, entirely normal. I also showed a score that was indicative of casein sensitivity as well. I asked a LOT of questions, and here are some of Dr. Fine's answers:

Thanks for this information. I can't figure out how to ask questions to Dr. Fine....I've posted a couple questions on the Enterolab website, but how do you actually ask Dr. Fine questions.....?

Oh I was 42 for Fecal IgA and 20 for Transglutaminase....

Jerry

[Nancym]

My understanding is Ttg is a normal human protein the body attacks mistakenly because it resembles gliadin. So you've got an autoimmune disease at this point. It is something that is common in celiacs. The protein coat on gliadin is similar to the one on Ttg, or something like that. So they're measuring antibodies (the attack dogs of the immune system) that are targetting Ttg.

The fat in stool test is the one that shows malabsorption which is indicative of lots of villious damage.

[Rachel--24]

I just want to understand the meaning of the Transglutaminase test....

I'm still trying to figure this out myself.

My results were...

IgA 16

tTG 15

and get this....

malabsorption 912 (yes, I was very sick with alot of weight loss)

I have no Celiac genes.

If tTG is specific for Celiac...how is it possible that I have elevated tTG??

Its been a year and a half and I still dont have a logical answer to this question.

Obviously in Enterolab testing tTG is not specific for Celiac....because I dont have Celiac. It may be specific for autoimmune response but in my case its not Celiac.

The best explanation I could find was this....

Coeliac disease is a T-cell-mediated autoimmune disease of the small intestine that is induced by ingestion of gluten proteins from wheat, barley, or rye. We postulate that Candida albicans is a trigger in the onset of coeliac disease. The virulence factor of C albicans-hyphal wall protein 1 (HWP1)-contains aminoacid sequences that are identical or highly homologous to known coeliac disease-related alpha-gliadin and gamma-gliadin T-cell epitopes. HWP1 is a transglutaminase substrate, and is used by C albicans to adhere to the intestinal epithelium. Furthermore, tissue transglutaminase and endomysium components could become covalently linked to the yeast. Subsequently, C albicans might function as an adjuvant that stimulates antibody formation against HWP1 and gluten, and formation of autoreactive antibodies against tissue transglutaminase and endomysium.

It makes more sense to me than any explanation I've seen from Enterolab.

I do have Candida....I've had it since the start of my illness.

[Nancym]

2) We do know that approximately 1% of Celiacs have a a gene different from the 2 main Celiac genes, but research just has not pinpointed the gene or gene combination for that 1% yet. So, it is entirely possible to have Celiac Disease without one of the two main genes. It is also possible to have positive results on your tests and malabsorption and not have at least one of the main Celiac genes, but having the genes increases the possibility of malabsorption and intestinal damage.

Because there are celiacs with some other gene that haven't been identified yet. Did you ever have a biopsy?

I have no Celiac genes.

If tTG is specific for Celiac...how is it possible that I have elevated tTG??

Its been a year and a half and I still dont have a logical answer to this question.

Obviously in Enterolab testing tTG is not specific for Celiac....because I dont have Celiac. It may be specific for autoimmune response but in my case its not Celiac.

[Rachel--24]

Because there are celiacs with some other gene that haven't been identified yet. Did you ever have a biopsy?

Nancy, I had bloodwork and biopsy....both negative.

I dont think I fall into the 1-2% of Celiacs without DQ2 or DQ8.

I dont think my tTG is specific for Celiac...my malabsorption did not improve after going gluten-free.

Unfortunately I had my biopsy 6 months after being gluten-free....so its pretty useless but I was not willing to do a challenge. I feel that even if they did the biopsy when I was at my worst and still eating gluten....it would have been negative.

The tTG in Enterolab testing is not specific for Celiac...too many people without Celiac genes have positive tTG in the stool test.

It doesnt correlate with the actual percentage of diagnosed Celiacs w/out a gene.

I also dont think its a matter of Enterolab "catching it early". I thought I was dying at one point so if they caught it early...I'd hate to see what would happen if I'd waited longer.

With negative bloodwork, negative biopsy, and no celiac genes...I think its pretty safe to say I dont have Celiac. There defiantely may be an autoimmune response to gluten going on....but then again I've got autoimmune stuff going on even w/out eating gluten.

So who knows what Enterolab's tTG represents when there is no evidence of Celiac???

I'm going to retest after 2 years off gluten (this summer) and the tTG should not be elevated.....if it is...there is something other than gluten causing elevated tissue transglutaminase.

[Nancym]

Right, but all that testing was done well after you'd gone gluten-free. I guess it doesn't rule out the possibility that you can have anti-Ttg due to something else not yet discovered but I don't think it is insignificant or unimportant (Not that you said it was). You shouldn't be producing antibodies against your own body, whatever the cause.

[Rachel--24]

I guess it doesn't rule out the possibility that you can have anti-Ttg due to something else not yet discovered but I don't think it is insignificant or unimportant (Not that you said it was). You shouldn't be producing antibodies against your own body, whatever the cause.

Yeah...if something else is causing it....I wanna know what it is....so I can make it stop.

I dont think that the tTG is insignificant (not that you said I did ). I do think that it means something. I just dont think that it is always indicating Celiac/villi damage in Enterolab's stool test.

I really think the tTG could be elevated for some other reason. If my next Enterolab test shows both anti-gliadin antibodies and anti-tTG to be within normal range....then I guess I will be proven wrong.

If the tTG is same or higher.....well then...it cant be from gluten.

[happygirl]

Rachel:

I was not tested by enterolab originally (i did bloodwork/biopsy), but when my health declined this year, I had it done. I started the diet Aug 2004 and did the Enterolab testing July/Aug 2006.

(And you know all I have gone through, and that I don't eat out, only eat my own prepared foods, and have severe gluten reactions...there is no question as to if I ever get glutened or not...I know it)

I have DQ8, and still had positive IgA and tTG. After two years.

But, my bloodwork (taken two months earlier) was normal. My biopsies taken that summer (August 06) and fall (November 06) with multiple biopsies in multiple locations, were all perfect.

What does this mean? I don't know (duh). Just wanted to share.

[Rachel--24]

What does this mean? I don't know (duh). Just wanted to share.

Laura.....I dont know either but I'm glad you shared.

I guess since I had the test already...I have something to compare with.

The first time I tested I had only been gluten-free for 4 months.....yet my numbers werent terribly high...with the exception of malabsorption....which was very high.

For new results I would not expect to see the numbers higher...they should definately be lower. My malabsorption should be ALOT lower. I have normal stools now....thanks to my super-strict-free-of-everything diet.

I'm mostly curious about the tTG. If its the same or higher I might seriously suspect candida.....based on the research I posted about.

If it is still elevated....it would be interesting to see what happens with the tTG after I get rid of the candida problem.

Well....assuming that I can actually stop feeding them ice cream.

[CMCM]

My understanding is that the presence of the IgA (antigliadin) antibodies PLUS the anti-tissue transglutaminase (ttg) are the "gold standard" for confirming a diagnosis of celiac disease in a blood test. Because of the shortcomings of blood tests (the villi damage must be fairly total for these antibodies to actually show up in the blood), Dr. Fine at Enterolab and other researchers agreed that evidence of immunologic reaction to gluten needed to come from a test located where food comes into direct contact with the tissue....hence the inside of the intestinal tract....the stool itself. Dr. Fine's research on microscopic colitis led him to the discovery that stool analysis is a way to assess gluten sensitivity years before celiac disease develops. Negative blood tests for celiac did not rule out the possibility of gluten sensitivity, and Dr. Fine wanted to see if the antigliadin IgA antibodies were present in the stools of research subjects. His initial data was astounding: in people with untreated celiac disease, stool analysis showed positively in 100% of the patients, whereas the standard blood test showed it in 76%. Thru all his subsequent tests, it appears that the stool test for IgA is far more sensitive than the blood tests. In addition, the stool test can reveal antibodies for up to a YEAR after the last gluten has been eaten, so no gluten challenge is needed if one has been gluten free for awhile, even for a number of months.