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Endomysial (A & G) antibodies - Coeliac disease
Antigen: IgA to tissue transglutaminase located in the muscularis mucosa. Note the staining of network of fibrous network around smooth muscle cells in the muscularis mucosa.
Clinical: Coeliac disease (gluten sensitivity)
Majority of the patients with coeliac disease are positive for endomysial antibodies.
Endomysial antibodies in IgA deficient patients
Antigen: IgG to tissue transglutaminase. In patients with IgA deficiency, assessment of IgG transglutaminase and endomysial antibodies is recommended.
Clinical: Coeliac disease
Skin antibodies - Pemphigus / Pemphigoid
Intercellular cement (pemphigus)
Antigen: This antigen (130 kDa desmoglein 3) can be visualised on primate oesophagus.
Disease: Active form of Pemphigus vulgaris (90%).
Basement membrane (pemphigoid)
Antigen: This antigen (180 kDa transmembrane protein (BP180)) can also be detected on primate oesophagus.
Disease: Associated with blistering or bullous pemphigoid (70%).
Both IgG antibodies
Mixture of intercellular cement and basement layer antibody.
Myocardial/Intercalated disc antibodies - Dressler's syndrome
Antigen: Range of targets (e.g. myosin, actin): Antifibrillary antibody binding to the striations of primate cardiac muscle.
Disease: Antibody found in autoimmune myocarditis, cardiomyopathy and Dressler's syndrome
2004: A 37 year old male with previous history of chest pains. He was then treated for pericarditis.
2012: Admission reason for severe chest pain
Examination and work-up
• CT coronary angiography showed no evidence of coronary disease
• Echocardiography unremarkable
• Cardiovascular examination was normal
• ECG was within normal
• Trans-thoracic echocardiogram was normal
• Blood tests showed no increase in his inflammatory markers
• The initial assessment - recurrent pericarditis
• Pain was not typical of pericarditis
• Also complained of recurrent migraine
• Neurological review normal
• Head MRI - a few tiny high bi-frontal sub-cortical bright areas and scarring (not new)
• ANA, ANCA and double stranded DNA titres were all negative
• Cardiac striations were negative. No reaction with skeletal muscle
• Intercalated disc antibody present (see arrow heads)
Clinical indication: Intercalated disc antibody has been reported in association with autoimmunity idiopathic recurrent acute pericarditis.
Salivary duct antibodies
Antigen: Primate parotid gland showing location of antigen; intra-cytoplasmic granules in the primary ductules and collecting ducts
Disease: Commonly found in 50% of patients with Sjögren's syndrome.