The high prevalence of autoantibodies to tissue transglutaminase in first-degree relatives of patients with type 1 diabetes is not associated with islet autoimmunity

OBJECTIVE - To determine the extent of celiac autoimmunity in type 1 diabet ic patients and the overlap between islet and celiac autoimmunity in their nondiabetic relatives. RESEARCH DESIGN AND METHODS - IgA antibodies to tissue transglutaminase wer e determined in serum taken from 433 type 1 diabetic patients and 1,442 non diabetic first-degree relatives. Samples with transglutaminase antibodies a bove the 97.5th percentile of 347 schoolchildren were also assayed for IgA anti-endomysial antibodies (EMAs). Markers of islet autoimmunity (islet cel l antibodies and autoantibodies to insulin, glutamate decarboxylase, and pr otein tyrosine phosphatase IA-2) had previously been measured in all relati ves. RESULTS - In the absence of known celiac disease, the prevalence of transgl utaminase antibody levels above the 97.5th percentile of the schoolchildren was 13.4% in diabetic patients and 7.0% in nondiabetic relatives. EMAs wer e found in addition to transglutaminase antibodies in 2.6% of probands and in 1.9% of first-degree relatives, but none of the schoolchildren. Transglu taminase antibodies were found to per sist in 10 of 30 patients and in 30 o f 59 relatives with follow-up samples taken at least 2 years after the init ial sample. Of 186 nondiabetic relatives with islet autoantibodies, only 10 also had transglutaminase antibodies. CONCLUSIONS - We found a high prevalence of celiac autoimmunity in patients and first-degree relatives of children with type 1 diabetes, but we found limited overlap between islet and celiac autoimmunity in nondiabetic relati ves. The high prevalence of celiac autoimmunity may be explained by shared genetic susceptibility and identifies a population within which screening f or the disease may be justified.