Psychiatric and Neurological Manifestations of Celiac Disease in Adults

Celiac disease (CD), a chronic inflammatory disorder of the intestines, affects 0.7% to 1.4% of the world's population. CD causes diarrhea, abdominal discomfort, bloating, flatulence, and, in rare cases, constipation in the digestive tract. Since the identification of gluten as the disease-causing antigen, CD patients have been treated with a gluten-free diet, which is advantageous but has limitations for certain patient groups. CD is associated with mood disorders, such as manic-depressive disease, schizophrenia, and bipolar disorder, as well as other disorders such as depression and anxiety. The relationship between CD and psychological issues is not entirely understood. Here, we look at the most recent psychiatric data as they pertain to CD, as well as the relevant psychiatric manifestations that have been associated with this condition. Clinicians should examine mental health factors when a CD diagnosis is established. More research is needed to understand the pathophysiology of CD's psychiatric manifestations.

Acid Suppression and Antibiotics Administered during Infancy Are Associated with Celiac Disease

OBJECTIVE

To investigate why certain at-risk individuals develop celiac disease (CD), we examined the association of proton pump inhibitors (PPI), histamine-2 receptor antagonists (H2RAs), and antibiotic prescriptions in the first 6 months of life with an early childhood diagnosis of CD.

STUDY DESIGN

A retrospective cohort study was performed using the Military Healthcare System database. Children with a birth record from October 1, 2001, to September 30, 2013, were identified. Outpatient prescription records were queried for antibiotic, PPI, and H2RA prescriptions in the first 6 months of life. Cox proportional hazards regression was used to calculate the hazard ratio (HR) of developing CD based on medication exposure. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified children with an outpatient visit for CD.

RESULTS

There were 968 524 children who met the inclusion criteria with 1704 cases of CD in this group. The median follow-up for the cohort was approximately 4.5 years. PPIs (HR, 2.23; 95% CI, 1.76-2.83), H2RAs (HR, 1.94; 95% CI, 1.67-2.26), and antibiotics (HR, 1.14; 95% CI, 1.02-1.28) were all associated with an increased hazard of CD.

CONCLUSIONS

There is an increased risk of developing CD if antibiotics, PPIs and H2RAs are prescribed in the first 6 months of life. Our study highlights modifiable factors, such as medication stewardship, that may change the childhood risk of CD.

Relevance of the air-water interfacial and foaming properties of (modified) wheat proteins for food systems

A shift from animal protein- to plant protein-based foods is crucial in transitioning toward a more sustainable global food system. Among food products typically stabilized by animal proteins, food foams represent a major category. Wheat proteins are ubiquitous and structurally diverse, which offers opportunities for exploiting them for food foam and air-water interface stabilization. Notably, they are often classified into those that are soluble in aqueous systems (albumins and globulins) and those that are not (gliadins and glutenins). However, gliadins are at least to an extent water extractable and thus surface active. We here provide a comprehensive overview of studies investigating the air-water interfacial and foaming properties of the different wheat protein fractions. Characteristics in model systems are related to the functional role that wheat proteins play in gas cell stabilization in existing wheat-based foods (bread dough, cake batter, and beer foam). Still, to further extend the applicability of wheat proteins, and particularly the poorly soluble glutenins, to other food foams, their modification is required. Different physical, (bio)chemical, and other modification strategies that have been utilized to alter the solubility and therefore the air-water interfacial and foaming properties of the gluten protein fraction are critically reviewed. Such approaches may open up new opportunities for the application of (modified) gluten proteins in other food products, such as plant-based meringues, whippable drinks, or ice cream. In each section, important knowledge gaps are highlighted and perspectives for research efforts that could lead to the rational design of wheat protein systems with enhanced functionality and overall an increased applicability in food industry are proposed.

Gluten Exorphins Promote Cell Proliferation through the Activation of Mitogenic and Pro-Survival Pathways

Celiac disease (CD) is a chronic and systemic autoimmune disorder that affects preferentially the small intestine of individuals with a genetic predisposition. CD is promoted by the ingestion of gluten, a storage protein contained in the endosperm of the seeds of wheat, barley, rye, and related cereals. Once in the gastrointestinal (GI) tract, gluten is enzymatically digested with the consequent release of immunomodulatory and cytotoxic peptides, i.e., 33mer and p31-43. In the late 1970s a new group of biologically active peptides, called gluten exorphins (GEs), was discovered and characterized. In particular, these short peptides showed a morphine-like activity and high affinity for the δ-opioid receptor (DOR). The relevance of GEs in the pathogenesis of CD is still unknown. Recently, it has been proposed that GEs could contribute to asymptomatic CD, which is characterized by the absence of symptoms that are typical of this disorder. In the present work, GEs cellular and molecular effects were in vitro investigated in SUP-T1 and Caco-2 cells, also comparing viability effects with human normal primary lymphocytes. As a result, GEs treatments increased tumor cell proliferation by cell cycle and Cyclins activation as well as by induction of mitogenic and pro-survival pathways. Finally, a computational model of GEs interaction with DOR is provided. Altogether, the results might suggest a possible role of GEs in CD pathogenesis and on its associated cancer comorbidities.

The role of skin inflammation, barrier dysfunction, and oral tolerance in skin sensitization to gluten-derived hydrolysates in a rat model

BACKGROUND

Adverse reactions to wheat-containing skin care products have been linked to food allergy development.

OBJECTIVES

To determine the role of skin barrier dysfunction and inflammation in sensitization to gluten-derived hydrolysates via the skin in Brown Norway rats with and without oral tolerance to wheat.

METHODS

Skin barrier defect was induced by mechanical disruption, and skin inflammation was induced by topical application of SLS or MC903. Unmodified, enzyme hydrolyzed, or acid hydrolyzed gluten products were applied to the skin three times per week for 5 weeks. Subsequently, rats were orally gavaged with unmodified gluten.

RESULTS

Wheat-naïve rats were readily sensitized to gluten hydrolysates via the skin. Skin barrier defect and skin inflammation had little effect on the skin sensitization and hydrolysate-specific IgE levels. Oral administration of unmodified gluten promoted the production of unmodified gluten-specific IgE in rats sensitized via the skin. Sensitization through intact skin, disrupted skin barrier, or inflamed skin was unable to break tolerance to unmodified gluten in rats on a wheat-containing diet.

CONCLUSIONS

Mechanical skin barrier disruption and skin inflammation play a limited role in experimental skin sensitization to gluten-derived hydrolysates.

Influence of damaged starch on thermal and rheological properties of wheat starch and wheat starch-gluten systems in water and sucrose

BACKGROUND

The granular integrity of starch granules is affected by the mechanical action of the milling-process, thus producing what is called damaged starch (DS). The effect of DS on bakery products was extensively studied, but there is not much information about the effect of this minor flour component on batter-type products in which there is a high amount of sucrose. The objective of this work was to study the influence of damaged wheat-starch on starch and starch-gluten systems dispersed in water and sucrose 500 g kg^-1 solution.

RESULTS

Thermal and pasting properties and the viscoelastic behavior of the systems were evaluated. Gelatinization enthalpy decreased when DS amount increased in the samples in both solvents. In starch-gluten systems, the degree of influence of DS on the gelatinization enthalpy was solvent-dependent. The presence of gluten minimized the effect of DS on the gelatinization process in water. The viscosity profile of starch and starch-gluten samples was reduced in both solvents when DS level increased. The influence of DS on the viscosity profile was solvent-dependent in starch-gluten systems. The presence of gluten lessened the influence of DS on the viscosity profile during the pasting process in sucrose solution. Higher DS levels decreased the viscoelastic behavior of the systems in both solvents and further reduced the viscoelastic behavior of the systems in sucrose solution.

CONCLUSION

These results contribute to understanding the influence of the DS levels on the batter properties of flour-based batter-type products, mainly those generated on starch and gluten-starch systems dispersed in sucrose solution. © 2022 Society of Chemical Industry.

On the Presence of Gluten-Cleaving Activity in Sodiomyces alkalinus and S. magadiensis Strains

Special enzymes are necessary for producing gluten-free foods, and specific proteolytic enzymes with gluten-degrading activity may be used as oral treatments for celiac disease. Enzymes of the kind were sought, identified, and preliminarily characterized in two strains of the alkaliphilic microscopic fungi Sodiomyces alkalinus and S. magadiensis. Post-glutamine cleaving activity was for the first time observed in the strains along with proline-cleaving activities of dipeptidyl peptidase 4 (DPP4) and proline aminopeptidase (PAP), allowing efficient hydrolysis of both proline/glutamine-rich gluten peptides and whole gluten. The optimal pH and pH-dependent stability were determined for the peptidases in question. All of the enzymes shown to cleave the prolyne/glutamine-containing bonds were assigned to the serine peptidase group and were found to be stable in moderately acidic and alkaline conditions. Owing to their activities, the peptidases are promising as tools to produce gluten-free foods and to design diets for gluten-intolerant patients.

Characterization of sonicated gluten protein and subsequent rheological properties of model dough and noodles

BACKGROUND

The present study aimed to investigate the effects of the thermo-mechanical and rheological properties of a wheat gluten-sonicated model dough and noodles, as well as the effects of ultrasonic frequency (20, 28, 40, 68 and 80 kHz) on the functional properties and structural features of gluten.

RESULTS

Water absorption, stability and developmental time, and viscoelastic behavior of gluten-sonicated model dough were all found to be improved. Water absorption, tensile resistance and stretching distance of noodles increased markedly, whereas cooking loss decreased. Ultrasonication at different frequencies also significantly affected gluten structure, including its surface hydrophobicity, micro-network structure, and secondary and tertiary structures. These alterations then caused changes in its functional characteristics. Compared to untreated gluten, sonicated gluten exhibited significantly increased oil and water capacities (8.75-15.26% and 100.65-127.71% higher than the untreated gluten, respectively), foaming and emulsifying properties, and increased solubility (63.46-98.83% higher than control). In addition, these findings indicated that 40 kHz was the likely resonance frequency of the cavitation bubble in the gluten solution. However, sodium dodecyl sulfate-polyacrylamide gel electrophoresis electropherograms revealed that such treatments did not affect the molecular weight of gluten, which was also consistent with its unchanged disulfide bond content.

CONCLUSION

The present study clarified the impact of frequency on the properties of gluten and model dough. The best frequency for modification of gluten was 40 kHz. Collectively, these findings suggest that ultrasonic technology has the potential for use in modifying wheat gluten and commercial noodle processing. © 2022 Society of Chemical Industry.

Physicochemical and Structural Properties of Gluten-Konjac glucomannan Conjugates Prepared by Maillard Reaction

Gluten (Glu) is important to wheat products by forming a three-dimensional matrix. This study aimed to investigate the physicochemical and structural properties of gluten after conjugation with konjac glucomannan (KGM) through the Maillard reaction. The study revealed that the degree of graft increased with the prolonged reaction time. The Glu-KGM conjugates were possessed of increased β-sheet but decreased α-helix and β-turn, as well as unfolding and loose tertiary structures as the reaction proceeded. Among three different proportions, the Glu-KGM 1:1 conjugate was proved to have the most excellent foaming and emulsifying properties, and could form more rigid and firm gelation structures, which could be related to the decreased particle size and increased zeta potential of the conjugate. Overall, the physicochemical and structural properties of gluten were significantly related to the KGM ratios as well as the reaction period.

The Immunobiology and Pathogenesis of Celiac Disease

Among human leukocyte antigen (HLA)-associated disorders, celiac disease has an immunopathogenesis that is particularly well understood. The condition is characterized by hypersensitivity to cereal gluten proteins, and the disease lesion is localized in the gut. Still, the diagnosis can be made by detection of highly disease-specific autoantibodies to transglutaminase 2 in the blood. We now have mechanistic insights into how the disease-predisposing HLA-DQ molecules, via presentation of posttranslationally modified gluten peptides, are connected to the generation of these autoantibodies. This review presents our current understanding of the immunobiology of this common disorder that is positioned in the border zone between food hypersensitivity and autoimmunity.

Why are western diet and western lifestyle pro-inflammatory risk factors of celiac disease?

The prevalence of celiac disease increased in recent years. In addition to the genetic and immunological factors, it appears that environmental determinants are also involved in the pathophysiology of celiac disease. Gastrointestinal infections impact the development of celiac disease. Current research does not directly confirm the protective effect of natural childbirth and breastfeeding on celiac disease. However, it seems that in genetically predisposed children, the amount of gluten introduced into the diet may have an impact on celiac disease development. Also western lifestyle, including western dietary patterns high in fat, sugar, and gliadin, potentially may increase the risk of celiac disease due to changes in intestinal microbiota, intestinal permeability, or mucosal inflammation. Further research is needed to expand the knowledge of the relationship between environmental factors and the development of celiac disease to define evidence-based preventive interventions against the development of celiac disease. The manuscript summarizes current knowledge on factors predisposing to the development of celiac disease including factors associated with the western lifestyle.

Studying the Role of Potato Powder on the Physicochemical Properties and Dough Characteristics of Wheat Flour

Potato flour (PF) is rich in health-promoting compounds that can improve the nutritional benefits of food products after blending with wheat flour. However, the incorporation of PF may influence the processing characteristics of mixed powders and the quality properties of products. In this study, the physicochemical properties, processing characteristics, and structures of mixed powders and their corresponding doughs with different PF content (0%, 10%, 20%, 30%, 40%, 60%, 80%, and 100%) were investigated. The addition of PF dramatically increased the fiber content from 0.09 to 1.10 g·kg^-1 but diluted the protein in wheat flour. The peak and final viscosity of mixed powders decreased (from 5111.00 to 1806.33 cP and 5195.33 to 2135.33 cP, respectively) with an increase in PF fraction. The incorporation of PF significantly increased gelatinization temperature. The rapidly digestible starch decreased from 30.48% to 19.67%, and resistant starch increased from 16.93% to 41.84% when the PF content increased from 0% to 100%. The water absorption, stability time, and development time decreased with an increase in PF levels. The G' and G″ of the dough decreased as the addition amount of PF increased, while tan δ presented a complex change tendency. Due to the decrease in protein content in the mixed powders, the addition of PF in wheat flour notably decreased the Hm values of doughs and total carbon dioxide volume produced during fermentation. Additionally, the SH and S-S contents decreased with an increase in PF fraction. Scanning electron microscopy results showed that when the PF content reached up to 80%, a poor and discontinuous gluten framework was formed in the dough. Results showed that PF affected the processing characteristics and gluten structures of wheat dough and was related to the interaction or competition for water molecules between protein and starch, as well as potato starch and wheat starch. Thus, the results of the present study can provide insights into the optimal level of addition of PF during the development of potato-based food products.

Primate liver tissue substrate in indirect immunofluorescence diagnostics for patients with dermatitis herpetiformis and celiac disease

Introduction

Dermatitis herpetiformis (DH) is a rare autoimmune, polymorphous blistering disorder, characterized by severe itch or burning sensation, which represents the cutaneous manifestation of celiac disease (CD). The current estimation of DH versus CD is around 1:8 and the affected individuals have a genetic predisposition. Pathogenetically, IgA autoantibodies against the epidermal transglutaminase, an essential constituent of the epidermis, cause DH and are reported to develop through cross-reaction with the tissue transglutaminase, with IgA auto-antibodies causing CD. Immunofluorescence techniques allow for a rapid diagnostics of the disease using patient sera. Evaluation of IgA endomysial deposition with indirect immunofluorescence on monkey oesophagus is highly specific, but moderately sensitive, with some operator-dependent variability. Recently, indirect immunofluorescence with monkey liver as a substrate has been proposed as an alternative, well-functioning diagnostic approach with higher sensitivity in CD.

Methods

The objective of our study was to evaluate whether monkey oesophagus or liver tissue shows advantage for diagnostics in patients with DH, compared to CD. To that end, sera of 103 patients with DH (n=16), CD (n=67) and 20 controls ere compared by 4 blinded experienced raters.

Results

For DH, we found a sensitivity of 94.2% for monkey liver (ML) compared to 96.2% in monkey oesophagus (ME), while specificity in ML was superior (91.6% versus 75%) to ME. In CD, ML had a sensitivity of 76.9% (ME 89.1%) and specificity of 98.3% (ME 94.1%).

Discussion

Our data show that ML substrate is well suitable for DH diagnostics.

Effect of fermentation on structural properties and antioxidant activity of wheat gluten by Bacillus subtilis

Bacillus subtilis has been extensively studied for its ability to inhibit the growth of harmful microorganisms and its high protease activity. In this study, Bacillus subtilis was used to ferment gluten and assess the effects of the fermentation process on the physicochemical, microstructure and antioxidant properties of gluten. The results of Fourier infrared spectroscopy (FT-IR) and circular chromatography (CD) showed a significant decrease in the content of α-helix structures and a significant increase in the content of β-sheet structures in gluten after fermentation (p < 0.05). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed that glutenin was degraded into small molecular peptides with a molecular weight of less than 26 kDa after 24 h of fermentation; meanwhile, the fermentation process significantly increased the free amino acid content of the samples (p < 0.05), reaching 1923.38 μg/mL at 120 h of fermentation, which was 39.46 times higher than that at 24 h of fermentation (p < 0.05). In addition, the fermented back gluten has higher free radical scavenging activity and iron reduction capacity. Therefore, fermented gluten may be used as a functional food to alleviate oxidative stress. This study provides a reference for the high-value application of gluten.

The emerging roles of bacterial proteases in intestinal diseases

Proteases are an evolutionarily conserved family of enzymes that degrade peptide bonds and have been implicated in several common gastrointestinal (GI) diseases. Although luminal proteolytic activity is important for maintenance of homeostasis and health, the current review describes recent advances in our understanding of how overactivity of luminal proteases contributes to the pathophysiology of celiac disease, irritable bowel syndrome, inflammatory bowel disease and GI infections. Luminal proteases, many of which are produced by the microbiota, can modulate the immunogenicity of dietary antigens, reduce mucosal barrier function and activate pro-inflammatory and pro-nociceptive host signaling. Increased proteolytic activity has been ascribed to both increases in protease production and decreases in inhibitors of luminal proteases. With the identification of strains of bacteria that are important sources of proteases and their inhibitors, the stage is set to develop drug or microbial therapies to restore protease balance and alleviate disease.

Wheat grain proteins: Past, present, and future

Background and Objectives

Research on wheat grain proteins is reviewed, including achievements over the past century and priorities for future research. The focus is on three groups of proteins that have major impacts on wheat quality and utilization: the gluten proteins which determine dough viscoelasticity but also trigger celiac disease in susceptible individuals, the puroindolines which are major determinants of grain texture and the amylase/trypsin inhibitors which are food and respiratory allergens and are implicated in triggering celiac disease and nonceliac wheat sensitivity.

Findings

Although earlier work focused on protein structure and properties, the development of genomics and high-sensitivity proteomics has resulted in the availability of a vast amount of information on the amino acid sequences of individual wheat proteins, including allelic variants of gluten proteins which are associated with good processing quality and of puroindolines, which are associated with a hard or soft grain texture, and on protein expression and polymorphism.

Conclusions

However, our ability to exploit this knowledge is limited by a lack of detailed understanding of the structure:function relationships of wheat proteins. In particular, we need to understand how the three-dimensional structures of the individual proteins determine their interactions with other grain components (to determine functional properties) and with the immune systems of susceptible consumers (to trigger adverse responses), how these interactions are affected by allelic variation, and how they can be manipulated.

Significance and Novelty

The article, therefore, identifies priorities for future research which should enable the adoption of a more rational approach to improving the quality of wheat grain proteins.

Intervention strategies in early childhood to prevent celiac disease-a mini-review

A higher intake of gluten during childhood is associated with increased risk of celiac disease, and the incidence of celiac disease peaks shortly after the time point when associations with higher gluten intake during the second and third year of life occur. Additional environmental factors are most likely necessary for celiac disease to develop. It is hypothesized that gastrointestinal infections increase gut permeability and exposure to gluten. Alternatively, infections may lead to gut dysbiosis and chronic inflammation, with leakage of self-antigens that mimic gluten peptides that leads to an autoimmune-like response. Different gluten interventions to prevent celiac disease have been proposed. Early clinical studies suggested an optimal time point introducing gluten between 4 and 6 months of age while the infant is being breastfed. However, later clinical trials on reduced gluten intake given to infants have shown no protection from celiac disease if gluten introduction was delayed or if gluten was introduced in small amounts during the child's first year of life. Still, more randomized clinical trials (RCTs) are warranted to answer the question if a reduced amount of gluten, not only at the time of introduction during infancy but also in a longer time frame, will prevent children at genetic risk from having lifelong celiac disease. It needs to be clarified whether dietary interventions are effective strategies to be proposed as future prevention of celiac disease in the general population. The present mini-review provides an overview of ongoing or completed RCTs that have focused on interventions during early childhood with the aim of preventing celiac disease.

Construction of a Fab Library Merging Chains from Semisynthetic and Immune Origin, Suitable for Developing New Tools for Gluten Immunodetection in Food

The observed increase in the prevalence of gluten-related disorders has prompted the development of novel immunological systems for gluten detection in foodstuff. The innovation on these methods relies on the generation of new antibodies, which might alternatively be obtained by molecular evolution methods such as phage display. This work presents a novel approach for the generation of a Fab library by merging semi-synthetic heavy chains built-up from a pre-existent recombinant antibody fragment (dAb8E) with an immune light chain set derived from celiac donors. From the initial phage population (10⁷ candidates) and after three rounds of selection and amplification, four different clones were isolated for further characterization. The phage Fab8E-4 presented the best features to be applied in an indirect ELISA for the detection of gluten in foods, resulting in improved specificity and sensitivity.

Toll-like Receptors and Celiac Disease

Celiac disease (CD) is an immune-mediated disorder triggered by dietary gluten intake in some genetically predisposed individuals; however, the additional non-HLA-related genetic factors implicated in CD immunopathogenesis are not well-defined. The role of the innate immune system in autoimmunity has emerged in the last few years. Genetic polymorphisms of some pattern-recognition receptors, including toll-like receptors (TLRs), have been associated with several autoimmune disorders. In this review, we summarize and discuss the evidence from basic research and clinical studies as regards the potential role of TLRs in CD immunopathogenesis. The evidence supporting the role of TLRs in CD immunopathogenesis is limited, especially in terms of basic research. However, differences in the expression and activation of TLRs between active CD patients from one side, and controls and treated CD patients from the other side, have been described in some clinical studies. Therefore, TLRs may be part of those non-HLA-related genetic factors implicated in CD etiopathogenesis, considering their potential role in the interaction between the host immune system and some environmental factors (including viral infections and gut microbiota), which are included in the list of candidate agents potentially contributing to the determination of CD risk in genetically predisposed individuals exposed to dietary gluten intake. Further basic research and clinical studies focused on TLRs in the context of CD and other gluten-related disorders are needed.

Evaluation of Gluten Exclusion for the Improvement of Rheumatoid Arthritis in Adults

There is currently a growing anti-gluten trend which, except for individuals with coeliac disease and non-coeliac gluten sensitivity (NCGS) for whom its intake is contraindicated, results in gluten (the main protein in wheat and other cereals) being considered harmful to health and excluded from diets, largely due to information distributed through social networks. However, in many cases the recommendation to exclude gluten from the diet goes beyond personal choice and is promoted by health professionals. This choice and/or recommendation is especially important to individuals with chronic inflammatory diseases such as rheumatoid arthritis (RA), for which this exclusion is justified to reduce the symptoms of the disease. The aim of this literature review is to assess whether there is scientific evidence to justify the elimination of gluten in patients with RA, neither coeliac nor with NCGS, to improve their symptoms and quality of life. The results of the search on gluten and RA carried out in the Embase database and the extraction of data from 16 articles included in the review are presented. No scientific evidence was found to recommend the exclusion of gluten in patients with RA.

Knowledge and awareness of celiac disease among the dental students

Consumption of gluten triggers an autoimmune disease known as celiac disease (CD). This is also referred to as nontropical sprue, celiac sprue, or gluten-sensitive enteropathy. Gluten is a protein present in wheat, barley, rye, and other grains. It is due to gluten that the dough becomes elastic and provides bread its chewy texture. The aim of this study is to assess the awareness and knowledge of CD among dental students. This survey is totally based on CD and its awareness among dental students. A survey was conducted among 100 students who are volunteers underneath. This survey contained questionnaires of CD causes, symptoms, treatment, etc., and the accrued was analyzed using SPSS statistics. The result shows that CD affects mainly the small intestine being chosen by 38.61% of students. The symptoms of CD as chronic diarrhea are chosen by 63.37%. The main cause of the disease is due to gluten chosen by 9.90%. Some of the gluten-free foods are chosen by 22.77% of students. In the Chi-square test, the association between the awareness of CD and students shows that postgraduate (PG) students are more aware than undergraduate (UG) students. However, this is not statistically significant since P > 0.05 (P = 0.088). The correlation graph says that the PGs are more aware than the undergraduates, and UGs have poor knowledge about this disease.

Gluten-Free Product Contribution to Energy and Macronutrient Intakes in Spanish Children and Adolescents with Celiac Disease

Gluten-free products (GFP) are a good choice for the replacement of cereals when following a gluten-free diet due to celiac disease (CD). However, commercial GFP are made with highly refined flours and may contain more fat, sugar, and salt, and less fiber and micronutrients than gluten-containing analogues, thus challenging the nutritional adequacy of the diet. The aim of this study is to assess the contribution of GFP to the diets of children and adolescents with CD. Food intakes were assessed in a cross-sectional study on 70 children and adolescents with CD (aged four to 18, 50% females), using three 24-h dietary records. GFP consumption reached 165 g a day and comprised mostly bread and fine bakery ware, followed by pasta. GFP contributed with a high percentage (>25%) to total energy, carbohydrates, fiber, and salt daily intakes and, to a lesser extent (<20%), to fat (including saturated fat), sugars and protein. Contribution of homemade products was testimonial. GFP contribution to total energy intake is significant and, consequently, relevant to the nutritional adequacy of the diet. Children and adolescents with CD could benefit from fat, saturated fat, and salt reduction, and fiber enrichment of processed GFP.

Impact of Wheat Arabinoxylan with Defined Substitution Patterns on the Heat-Induced Polymerization Behavior of Gluten

To further depict the interaction mechanism of wheat arabinoxylan (AX) and gluten proteins upon thermal processing, AX was enzymatically tailored with defined substitution patterns and the impact on the heat-induced polymerization behavior of gluten was comparatively studied. The results showed that tailormade AX promoted the formation of glutenin-glutenin and glutenin-gliadin macrocrosslinks upon heating, with the optimal effect detected for AX depleted of Araf of disubstituted Xylp. The tailormade AX, especially AX depleted of monosubstituted Xylp, facilitated the polymerization ability of α-gliadin into glutenin compared with untailored AX. The unfolding process of gluten was partially impeded by AX upon heating, while the tailormade AX promoted the unfolding process. AX could bury Trp and Tyr upon polymerization of glutenin and gliadin and induced the change of the disulfide bridge conformation to a less-stable state, while the effect was alleviated with tailormade AX. The enhanced polymerization with tailormade AX strengthened the gluten network and induced more heterogeneously distributed large protein aggregates.

The modulation of macrophage subsets in celiac disease pathogenesis

BACKGROUND

So far, limited studies have focused on the role of Macrophages (MQs) in the development or progression of celiac disease (CD). Researchers believe that increasing knowledge about the function of MQs in inflammatory disorders plays a critical role in finding a new treatment for these kinds of diseases.

MAIN BODY

CD is a permanent autoimmune intestinal disorder triggered by gluten exposure in predisposed individuals. This disorder happens due to the loss of intestinal epithelial barrier integrity characterized by dysregulated innate and adaptive immune responses. MQs are known as key players of the innate immune system that link innate and adaptive immunity. MQs of human intestinal lamina propria participate in maintaining tissue homeostasis, and also intestinal inflammation development. Previous studies suggested that gliadin triggers a proinflammatory phenotype (M1 MQ) in human primary MQs. Moreover, M2-related immunosuppressive mediators are also present in CD. In fact, CD patients present an impaired transition from pro-inflammatory to anti-inflammatory responses due to inappropriate responses to gliadin peptides.

CONCLUSION

The M1/M2 MQs polarization balancing regulators can be considered novel therapeutic targets for celiac disease.

Patient Use of Complementary and Alternative Medicine for Psoriasis Vulgaris and Factors Believed to Trigger the Disease: a Multicenter Cross-Sectional Study With 1621 Patients

INTRODUCTION

Due to the chronic recurrent nature of psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue.

OBJECTIVES

To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV.

METHODS

The patients sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet.

RESULTS

Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI scores and DLQI of those using CAM were significantly higher. CAM use was significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%.

CONCLUSIONS

Patients CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians.