Necrotizing enterocolitis: diagnosis with plasma IgG anti-tissue transglutaminase antibodies.

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory gastrointestinal disease in neonates. We aimed to evaluate the potential of IgG anti-tissue transglutaminase antibodies (IgG tTG) as early biomarkers for NEC.

Method: We conducted a prospective observational study, collecting plasma from 60 neonates with abdominal distension (AD), which were divided into the NEC (n = 30) and the controls (n = 30) according to the follow-up results, and used the autoantigen microarray to identify for NEC-associated autoantibodies. An Enzyme-linked immunosorbent assay (ELISA) was utilized to measure plasma IgG tTG levels in a validation study (NEC n = 43, controls n = 20).

Results: Microarray analysis indicated significantly elevated IgG tTG levels in neonates with NEC compared to controls (P < 0.001). ELISA further confirmed the significant elevation of IgG tTG in neonates with NEC (P < 0.001). IgG tTG effectively distinguished neonates with NEC from the controls, with an area under the curve (AUC) of 0.8674 (sensitivity of 72.09% and specificity of 95%). Encouragingly, IgG tTG levels were significantly higher in neonates with NEC I than in controls (P < 0.001). Additionally, as clinical conditions of neonates with NEC improved, the IgG tTG levels declined (P = 0.0159).

Conclusion: IgG tTG has potential as a biomarker for early diagnosis of NEC and predicting its prognosis after treatment.

Impact: Our results demonstrate that IgG anti-tissue transglutaminase antibodies possess significant diagnostic value for NEC. IgG anti-tissue transglutaminase antibodies can serve as a biomarker for early diagnosis NEC and its prognosis of treatment. The relationship between IgG anti-tissue transglutaminase antibodies and immune diseases may shed light on the pathogenesis of NEC, potentially opening new therapeutic avenues for preventing and treating neonates with NEC.