A Review of the Methods Available for the Detection of Antibodies Against Transglutaminase and Deaminated Gliadin in Celiac Disease, Traditional and Emerging Technologies.

Celiac Disease (CD) is an immune-mediated enteropathy where serological testing, centered on IgA anti Tissue Transglutaminase 2 (anti-TG2) and IgA anti Endomysium antibodies (anti-EMA), is the diagnostic cornerstone. Anti-TG2 is recognized as the most sensitive marker, while anti-EMA is the most specific. This review examines the performance characteristics, advantages, and limitations of traditional and emerging technologies for CD serology. Traditional platforms include ELISA - a cost-effective, open platform used for quantitative anti-TG2 and anti-DGP detection and IIF for anti-EMA, which, despite being labor-intensive and operator-dependent, maintains high specificity by detecting anti-TG2 in its native conformation. Newer technologies prioritize automation in view of clinical laboratory demands. CLIA and FEIA are fully automated systems that offer enhanced analytical sensitivity and rapid workflow. Meta-analyses confirm that the diagnostic accuracy of IgA anti-TG2 is statistically equivalent across CLIA (Sens. 0.98, Spec. 0.97), FEIA (Sens. 0.97, Spec. 0.99), and ELISA (Sens. 0.96, Spec. 0.97). However, CLIA often requires higher diagnostic thresholds for biopsy-sparing protocols. Emerging solutions include Multiplex Flow Immunoassays (MFI) /Microarrays, which enable simultaneous multi-isotype antibody detection with high concordance to reference assays (PPA 96.0 %, NPA 98.0 % for IgA anti-TG2) while Point-of-Care Tests (POCTs) provide rapid, equipment-free screening for primary care, though they exhibit moderate sensitivity compared to laboratory assays. The overall trend favors automated and multiplexed methods, improving efficiency and supporting biopsy-sparing strategies based on robust quantitative autoantibody profiling.