In celiac disease, anti-endomysial antibodies are most associated with which tissue?

• A. Tissue transglutaminase
• B. Endomysium
• C. Gliadin
• D. Desmoglein

Answer: (B)

Anti-endomysial antibodies in celiac disease target antigens located in the endomysium, the connective tissue surrounding muscle fibers. This is why endomysium is the tissue most associated with these antibodies—the classic indirect immunofluorescence test uses endomysial tissue as the substrate. While tissue transglutaminase is a key autoantigen in celiac disease and anti-tTG antibodies are also used clinically, the question specifically points to the tissue associated with anti-endomysial antibodies, which is the endomysium. Gliadin relates to gluten components and immune responses to gluten, not the endomysial tissue, and desmoglein is linked to other autoimmune conditions like pemphigus.