Cross-reacting antibodies in coeliac disease?

See article on page 168 Most patients with coeliac disease have antibodies to wheat gliadin, reticulin, and endomysium. In 1997 a seminal paper showed that at least a substantial fraction of anti-endomysial antibodies (EMA) recognises the endogenous enzyme tissue transglutaminase (tTG).1 However, antibodies recognising other antigens can also be found and in this issue (see page 168) Krupickova and colleagues attempt to characterise these antibodies. Anti-gliadin antibodies (AGA) were isolated from coeliac serum samples using (semi)purified α-gliadin as the substrate. These antibodies were tested for specificity using a synthetic α-gliadin peptide competition assay. This important study is the first of its kind. An interesting finding is that the antibody responses are directed towards a limited set of epitopes. These epitopes do not overlap with peptides recognised by small intestinal HLA-DQ restricted T cells,2 3 but our current knowledge is too limited to …