351
|
Vazquez-Roque M, Oxentenko AS. Nonceliac Gluten Sensitivity. Mayo Clin Proc 2015; 90:1272-7. [PMID: 26355401 DOI: 10.1016/j.mayocp.2015.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 12/21/2022]
Abstract
Nonceliac gluten sensitivity (NCGS) is the clinical term used to describe gastrointestinal (GI) and/or extraintestinal symptoms associated with gluten ingestion. The prevalence of NCGS is unknown. The condition has clinical features that overlap with those of celiac disease (CD) and wheat allergy (WA). The pathophysiologic process in NCGS is thought to be through an innate immune mechanism, whereas CD and WA are autoimmune- and allergen-mediated, respectively. However, dietary triggers other than gluten, such as the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, have been implicated. Currently, no clinical biomarker is available to diagnose NCGS. Exclusion of CD and WA is necessary in the evaluation of a patient suspected to have NCGS. The onset of symptoms in patients with NCGS can occur within hours or days of gluten ingestion. Patients with NCGS have GI and extraintestinal symptoms that typically disappear when gluten-containing grains are eliminated from their diets. However, most patients suspected to have NCGS have already initiated a gluten-free diet at the time of an evaluation. A gluten elimination diet followed by a monitored open challenge of gluten intake to document recurrence of GI and/or extraintestinal symptoms can sometimes be helpful. If NCGS is strongly suggested, then a skilled dietitian with experience in counseling on gluten-free diets can provide proper patient education. Additional research studies are warranted to further our understanding of NCGS, including its pathogenesis and epidemiology, and to identify a biomarker to facilitate diagnosis and patient selection for proper management.
Collapse
|
352
|
Vriezinga SL, Schweizer JJ, Koning F, Mearin ML. Coeliac disease and gluten-related disorders in childhood. Nat Rev Gastroenterol Hepatol 2015; 12:527-36. [PMID: 26100369 DOI: 10.1038/nrgastro.2015.98] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gluten-related disorders such as coeliac disease, wheat allergy and noncoeliac gluten sensitivity are increasingly being diagnosed in children. Coeliac disease occurs frequently, affecting 1-3% of the Western population. The condition manifests at a very young age, more so in girls, and is related to the HLA genotype. Coeliac disease might be considered a public health problem and, as primary prevention is not possible, the debate on mass screening should be reopened. Wheat proteins, including gluten, are responsible for one of the most common food allergies in children: wheat allergy. Unlike coeliac disease and wheat allergy, noncoeliac gluten sensitivity is an unclear and controversial entity. These three gluten-related disorders are treated with a gluten-free diet. In coeliac disease, the diet should be strictly followed, whereas wheat allergy only requires wheat elimination and in noncoeliac gluten sensitivity occasional trials of gluten reintroduction can be done. A good diagnostic work-up is important for gluten-related disorders in childhood to avoid unnecessary restrictive diets in children. In this Review, we provide an overview of the pathogenesis, diagnosis and management of the most common gluten-related disorders in children.
Collapse
Affiliation(s)
- Sabine L Vriezinga
- Department of Paediatrics, Leiden University Medical Centre, Albinusdreef 2/PO 9600, 2300 RC Leiden, Netherlands
| | - Joachim J Schweizer
- Department of Paediatrics, Leiden University Medical Centre, Albinusdreef 2/PO 9600, 2300 RC Leiden, Netherlands
| | - Frits Koning
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Albinusdreef 2/PO 9600, 2300 RC Leiden, Netherlands
| | - M Luisa Mearin
- Department of Paediatrics, Leiden University Medical Centre, Albinusdreef 2/PO 9600, 2300 RC Leiden, Netherlands
| |
Collapse
|
353
|
Abstract
Coeliac disease is a treatable, gluten-induced disease that often occurs concurrently with other autoimmune diseases. In genetic studies since 2007, a partial genetic overlap between these diseases has been revealed and further insights into the pathophysiology of coeliac disease and autoimmunity have been gained. However, genetic screening is not sensitive and specific enough to accurately predict disease development. The current method to diagnose individuals with coeliac disease is serological testing for the presence of autoantibodies whilst the patient is on a regular, gluten-containing diet, followed by gastroduodenoscopy with duodenal biopsy. Serological test results can also predict the probability of coeliac disease development, even if asymptomatic. In patients with autoimmune diseases known to occur alongside coeliac disease (particularly type 1 diabetes mellitus or thyroid disorders), disease screening-and subsequent treatment if coeliac disease is detected-could have beneficial effects on progression or potential complications of both diseases, owing to the effectiveness of gluten-free dietary interventions in coeliac disease. However, whether diagnosis of coeliac disease and subsequent dietary treatment can prevent autoimmune diseases is debated. In this Review, the genetic and immunological features of coeliac disease, overlap with other autoimmune diseases and implications for current screening strategies will be discussed.
Collapse
|
354
|
Elli L, Roncoroni L, Bardella MT. Non-celiac gluten sensitivity: Time for sifting the grain. World J Gastroenterol 2015; 21:8221-8226. [PMID: 26217073 PMCID: PMC4507091 DOI: 10.3748/wjg.v21.i27.8221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/01/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
In the last few years, a new nomenclature has been proposed for the disease induced by the ingestion of gluten, a protein present in wheat, rice, barley and oats. Besides celiac disease and wheat allergy, the most studied forms of gluten-related disorders characterized by an evident immune mechanism (autoimmune in celiac disease and IgE-mediated in wheat allergy), a new entity has been included, apparently not driven by an aberrant immune response: the non-celiac gluten sensitivity (NCGS). NCGS is characterized by a heterogeneous clinical picture with intestinal and extraintestinal symptoms arising after gluten ingestion and rapidly improving after its withdrawal from the diet. The pathogenesis of NCGS is largely unknown, but a mixture of factors such as the stimulation of the innate immune system, the direct cytotoxic effects of gluten, and probably the synergy with other wheat molecules, are clues for the complicated puzzle. In addition, the diagnostic procedures still remain problematic due to the absence of efficient diagnostic markers; thus, diagnosis is based upon the symptomatic response to a gluten-free diet and the recurrence of symptoms after gluten reintroduction with the possibility of an important involvement of a placebo effect. The temporary withdrawal of gluten seems a reasonable therapy, but the timing of gluten reintroduction and the correct patient management approach are have not yet been determined.
Collapse
|
355
|
Husby S, Murray J. Non-celiac gluten hypersensitivity: What is all the fuss about? F1000PRIME REPORTS 2015; 7:54. [PMID: 26097727 PMCID: PMC4447038 DOI: 10.12703/p7-54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-celiac gluten sensitivity (NCGS) has been introduced recently as a potentially common disease on the basis of studies of patients with claimed reactivity to gluten but without the characteristics of celiac disease (CD). CD is characterized by antibody reactivity toward the autoantigen transglutaminase 2, characteristic histological abnormalities of the small intestine, and an almost obligatory genetic haplotype (HLA-DQ2 or DQ8). The diagnosis of NCGS is based largely on the clinical suspicion of hyper-reactivity to gluten and the absence of the characteristics of CD. Few published studies have used double-blind placebo-controlled food challenges (DBPCFCs) for the diagnosis of NCGS, and none in children. Innate immune reactivity to amylase trypsin inhibitors has been suggested as the pathogenic principle in NCGS, but confirmatory evidence is lacking. Also, further clinical studies including DBPCFCs are needed.
Collapse
Affiliation(s)
- Steffen Husby
- Hans Christian Andersen Children‘s Hospital, Odense University Hospital29 Sdr. Boulevard, DK-5000 Odense CDenmark
| | - Joseph Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic200 1st St SW, Rochester, MN 55905USA
| |
Collapse
|
356
|
Mansueto P, D’Alcamo A, Seidita A, Carroccio A. Food allergy in irritable bowel syndrome: The case of non-celiac wheat sensitivity. World J Gastroenterol 2015; 21:7089-109. [PMID: 26109796 PMCID: PMC4476871 DOI: 10.3748/wjg.v21.i23.7089] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/04/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, having a prevalence of 12%-30% in the general population. Most patients with IBS attribute their symptoms to adverse food reactions. We review the role of diet in the pathogenesis of IBS and the importance of dietary factors in the management of these patients. The MEDLINE electronic database (1966 to Jan 2015) was searched using the following keywords: "food", "diet", "food allergy", "food hypersensitivity", "food intolerance", "IBS", "epidemiology", "pathogenesis", "pathophysiology", "diagnosis", "treatment". We found 153 eligible papers; 80 were excluded because: not written in English, exclusive biochemical and experimental research, case reports, reviews, and research otherwise not relevant to our specific interest. We selected 73 papers: 43 original papers, 26 reviews and 4 letters to the editor. These papers focused on IBS pathogenesis, the association between IBS and atopy, and between IBS and food allergy, the relationship between IBS and non-celiac wheat sensitivity, the role of diet in IBS. Pending further scientific evidence, a cautious approach is advisable but the concept of food allergy should be included as a possible cause of IBS, and a dietary approach may have a place in the routine clinical management of IBS.
Collapse
|
357
|
Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, Roncoroni L, Bardella MT. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol 2015; 21:7110-7119. [PMID: 26109797 PMCID: PMC4476872 DOI: 10.3748/wjg.v21.i23.7110] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/03/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Cereal crops and cereal consumption have had a vital role in Mankind’s history. In the recent years gluten ingestion has been linked with a range of clinical disorders. Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders. Similar clinical manifestations can be observed in these disorders, yet there are peculiar pathogenetic pathways involved in their development. Celiac disease and wheat allergy have been extensively studied, while non-celiac gluten sensitivity is a relatively novel clinical entity, believed to be closely related to other gastrointestinal functional syndromes. The diagnosis of celiac disease and wheat allergy is based on a combination of findings from the patient’s clinical history and specific tests, including serology and duodenal biopsies in case of celiac disease, or laboratory and functional assays for wheat allergy. On the other hand, non-celiac gluten sensitivity is still mainly a diagnosis of exclusion, in the absence of clear-cut diagnostic criteria. A multimodal pragmatic approach combining findings from the clinical history, symptoms, serological and histological tests is required in order to reach an accurate diagnosis. A thorough knowledge of the differences and overlap in clinical presentation among gluten-related disorders, and between them and other gastrointestinal disorders, will help clinicians in the process of differential diagnosis.
Collapse
|
358
|
Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, Cellier C, Cristofori F, de Magistris L, Dolinsek J, Dieterich W, Francavilla R, Hadjivassiliou M, Holtmeier W, Körner U, Leffler DA, Lundin KEA, Mazzarella G, Mulder CJ, Pellegrini N, Rostami K, Sanders D, Skodje GI, Schuppan D, Ullrich R, Volta U, Williams M, Zevallos VF, Zopf Y, Fasano A. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts' Criteria. Nutrients 2015; 7:4966-77. [PMID: 26096570 PMCID: PMC4488826 DOI: 10.3390/nu7064966] [Citation(s) in RCA: 338] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/29/2015] [Accepted: 06/15/2015] [Indexed: 12/19/2022] Open
Abstract
Non-Celiac Gluten Sensitivity (NCGS) is a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected by either celiac disease or wheat allergy. Given the lack of a NCGS biomarker, there is the need for standardizing the procedure leading to the diagnosis confirmation. In this paper we report experts’ recommendations on how the diagnostic protocol should be performed for the confirmation of NCGS. A full diagnostic procedure should assess the clinical response to the gluten-free diet (GFD) and measure the effect of a gluten challenge after a period of treatment with the GFD. The clinical evaluation is performed using a self-administered instrument incorporating a modified version of the Gastrointestinal Symptom Rating Scale. The patient identifies one to three main symptoms that are quantitatively assessed using a Numerical Rating Scale with a score ranging from 1 to 10. The double-blind placebo-controlled gluten challenge (8 g/day) includes a one-week challenge followed by a one-week washout of strict GFD and by the crossover to the second one-week challenge. The vehicle should contain cooked, homogeneously distributed gluten. At least a variation of 30% of one to three main symptoms between the gluten and the placebo challenge should be detected to discriminate a positive from a negative result. The guidelines provided in this paper will help the clinician to reach a firm and positive diagnosis of NCGS and facilitate the comparisons of different studies, if adopted internationally.
Collapse
Affiliation(s)
- Carlo Catassi
- Department of Pediatrics, Università Politecnica delle Marche, 60123 Ancona, Italy.
| | - Luca Elli
- Centre for the Prevention and Diagnosis of Celiac Disease/Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan 20122, Italy.
| | - Bruno Bonaz
- Clinique Universitaire d'Hépato-Gastroenterologie, CHU de Grenoble, 38043 Grenoble Cedex 09, France.
| | - Gerd Bouma
- Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands.
| | - Antonio Carroccio
- Department of Internal Medicine, "Giovanni Paolo II" Hospital, Sciacca (AG) and University of Palermo, Sciacca 92019, Italy.
| | - Gemma Castillejo
- Paediatric Gastroenterology Unit, Hospital Sant Joan de Reus, 43201 Reus, Spain.
| | - Christophe Cellier
- Service d'Hépato-gastro-entérologie et Endoscopie Digestive, Hôpital Européen Georges Pompidou, 75015 Paris, France.
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy.
| | - Laura de Magistris
- Department of Internal and Experimental Medicine Magrassi-Lanzara, Second University of Naples, 80131 Naples, Italy.
| | - Jernej Dolinsek
- Gastroenterology Unit, Department of Pediatrics, University Medical Centre Maribor, Maribor 2000, Slovenia.
| | | | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, University of Bari, Bari 70124, Italy.
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences and University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Wolfgang Holtmeier
- Division of Gastroenterology and Internal Medicine, Hospital Porz am Rhein, Köln 51149, Germany.
| | - Ute Körner
- Practice of Nutrition Therapy Allergology and Gastroenterology, Köln 50935, Germany.
| | - Dan A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | - Knut E A Lundin
- Seksjon for Gastromedisin, Avdeling for Transplantasjonsmedisin, OUS Rikshospitalet Senter for Immunregulering, Oslo University, 0424 Oslo, Norway.
| | - Giuseppe Mazzarella
- Institute of Food Sciences-CNR, Lab. Immuno-Morphology, 83100 Avellino, Italy.
| | - Chris J Mulder
- Department of Gastroenterology, VU University Medical Center, Amsterdam, the Netherlands.
| | | | - Kamran Rostami
- Department of Gastroenterology, Alexandra Hospital, Redditch B98 7UB, UK.
| | - David Sanders
- Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital and University of Sheffield Medical School, Sheffield S10 2JF, UK.
| | - Gry Irene Skodje
- Division of Clinical Nutrition, Oslo University Hospital, 0424 Oslo, Norway,.
| | - Detlef Schuppan
- University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany.
| | - Reiner Ullrich
- Charité-Universitätsmedizin Berlin, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, 12203 Berlin, Germany.
| | - Umberto Volta
- Department of Medical and Surgical Sciences University of Bologna, St. Orsola-Malpighi Hospital via Massarenti 9, 40138 Bologna, Italy.
| | | | - Victor F Zevallos
- University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany.
| | - Yurdagül Zopf
- Medical Clinic 1, University of Erlangen, 91054 Erlangen, Germany.
| | - Alessio Fasano
- Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA 02114, USA.
| |
Collapse
|
359
|
Affiliation(s)
- S. Scheurer
- Molecular Allergology; Paul-Ehrlich-Institut; Langen Germany
| | - M. Toda
- Molecular Allergology; Paul-Ehrlich-Institut; Langen Germany
| | - S. Vieths
- Molecular Allergology; Paul-Ehrlich-Institut; Langen Germany
| |
Collapse
|
360
|
Barilli A, Rotoli BM, Visigalli R, Ingoglia F, Cirlini M, Prandi B, Dall'Asta V. Gliadin-mediated production of polyamines by RAW264.7 macrophages modulates intestinal epithelial permeability in vitro. Biochim Biophys Acta Mol Basis Dis 2015; 1852:1779-86. [PMID: 26047680 DOI: 10.1016/j.bbadis.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/28/2015] [Accepted: 06/01/2015] [Indexed: 01/22/2023]
Abstract
Celiac disease (CD) is an immune-mediated enteropathy sustained by dietary gluten in susceptible individuals, and characterized by a complex interplay between adaptive and innate responses against gluten peptides (PTG). In a recent contribution we have demonstrated that the treatment with PTG induces the expression and activity of arginase in both murine macrophages and human monocytes from healthy subjects, thus suggesting a role for arginine and its metabolites in gluten-triggered response of these cells. Here we further explore this field, by addressing the effects of PTG on polyamine synthesis and release in murine RAW264.7 macrophages, and how they affect epithelial permeability of Caco-2 monolayers. Results obtained show a massive production and release of putrescine by macrophages upon incubation with gluten peptides; this, in turn, causes a decrease in TEER in epithelial cells, indicating that PTG-driven secretion of polyamines by macrophages has a role in the modulation of intestinal permeability in vitro. At a molecular level, putrescine production appears referable to the activation of C/EBPβ transcription factor, which is known to be responsible for arginase induction in activated macrophages and is a crucial mediator of inflammation. Whether these pathways are stimulated also in vivo deserves to be further investigated, as well as their role in gluten-driven cellular and intestinal defects typical of CD patients.
Collapse
Affiliation(s)
- Amelia Barilli
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, SBiBiT, Università degli Studi di Parma, Via Volturno 39, 43125 Parma, Italy
| | - Bianca Maria Rotoli
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, SBiBiT, Università degli Studi di Parma, Via Volturno 39, 43125 Parma, Italy
| | - Rossana Visigalli
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, SBiBiT, Università degli Studi di Parma, Via Volturno 39, 43125 Parma, Italy
| | - Filippo Ingoglia
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, SBiBiT, Università degli Studi di Parma, Via Volturno 39, 43125 Parma, Italy
| | - Martina Cirlini
- Dipartimento di Scienze degli Alimenti, Università degli Studi di Parma, Parco Area delle Scienze 49/A, 43124 Parma, Italy
| | - Barbara Prandi
- Dipartimento di Scienze degli Alimenti, Università degli Studi di Parma, Parco Area delle Scienze 49/A, 43124 Parma, Italy
| | - Valeria Dall'Asta
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, SBiBiT, Università degli Studi di Parma, Via Volturno 39, 43125 Parma, Italy.
| |
Collapse
|
361
|
Lundin KEA, Qiao SW, Snir O, Sollid LM. Coeliac disease - from genetic and immunological studies to clinical applications. Scand J Gastroenterol 2015; 50:708-17. [PMID: 25846940 DOI: 10.3109/00365521.2015.1030766] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coeliac disease is a common and important gastrointestinal disease. It affects at least 1%, most Western European populations and in Nordic countries it is even more frequent. It is strongly associated with certain Human Leukocyte Antigen-DQ genes and triggered by ingestion of wheat gluten and related cereals from rye and barley. The diagnosis relies on a combination of clinical signs, serology and small intestinal biopsy. Work during the last couple of decades has shown that gluten-specific, Human Leukocyte Antigen-DQ-restricted T-cells in the intestinal mucosa are of paramount importance in the disease process. The gluten peptides are chemically modified by the endogenous enzyme transglutaminase 2, the same enzyme that serves as target in today's sensitive serological tests for coeliac disease. The increasing knowledge on the disease process allows for development of improved diagnosis, patient care and new treatment modalities.
Collapse
Affiliation(s)
- Knut E A Lundin
- Department of Gastroenterology, Oslo University Hospital-Rikshospitalet , Oslo , Norway
| | | | | | | |
Collapse
|
362
|
Valerii MC, Ricci C, Spisni E, Di Silvestro R, De Fazio L, Cavazza E, Lanzini A, Campieri M, Dalpiaz A, Pavan B, Volta U, Dinelli G. Responses of peripheral blood mononucleated cells from non-celiac gluten sensitive patients to various cereal sources. Food Chem 2015; 176:167-74. [DOI: 10.1016/j.foodchem.2014.12.061] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/25/2014] [Accepted: 12/15/2014] [Indexed: 01/02/2023]
|
363
|
Kim SM, Mayassi T, Jabri B. Innate immunity: actuating the gears of celiac disease pathogenesis. Best Pract Res Clin Gastroenterol 2015; 29:425-35. [PMID: 26060107 PMCID: PMC4465077 DOI: 10.1016/j.bpg.2015.05.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 01/31/2023]
Abstract
Celiac disease is a T cell mediated immune disorder characterized by the loss of oral tolerance to dietary gluten and the licensing of intraepithelial lymphocytes to kill intestinal epithelial cells, leading to villous atrophy. Innate immunity plays a critical role in both of these processes and cytokines such as interleukin-15 and interferon-α can modulate innate processes such as polarization of dendritic cells as well as intraepithelial lymphocyte function. These cytokines can be modulated by host microbiota, which can also influence dendritic cell function and intraepithelial lymphocyte homeostasis. We will elaborate on the role of interleukin-15, interferon-α, and the microbiota in modulating the processes that lead to loss of tolerance to gluten and tissue destruction in celiac disease.
Collapse
Affiliation(s)
- Sangman Michael Kim
- Committee on Immunology, University of Chicago, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Toufic Mayassi
- Committee on Immunology, University of Chicago, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Bana Jabri
- Committee on Immunology, University of Chicago, Chicago, IL 60637, USA; Department of Medicine, University of Chicago, Chicago, IL 60637, USA; Department of Pathology, University of Chicago, Chicago, IL 60637, USA; Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA.
| |
Collapse
|
364
|
Ricaño-Ponce I, Wijmenga C, Gutierrez-Achury J. Genetics of celiac disease. Best Pract Res Clin Gastroenterol 2015; 29:399-412. [PMID: 26060105 DOI: 10.1016/j.bpg.2015.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/26/2015] [Indexed: 01/31/2023]
Abstract
New insights into the underlying molecular pathophysiology of celiac disease (CeD) over the last few years have been guided by major advances in the fields of genetics and genomics. The development and use of the Immunochip genotyping platform paved the way for the discovery of 39 non-HLA loci associated to CeD, and for follow-up functional genomics studies that pinpointed new disease genes, biological pathways and regulatory elements. By combining information from genetics with gene expression data, it has become clear that CeD is a disease with a dysregulated immune response, which can probably occur in a variety of immune cells. This type of information is crucial for our understanding of the disease and for providing leads for developing alternative therapies to the current gluten-free diet. In this review, we place these genetic findings in a wider context and suggest how they can assist the clinical care of CeD patients.
Collapse
Affiliation(s)
- Isis Ricaño-Ponce
- University of Groningen, University Medical Center Groningen, Department of Genetics, 9700 RB Groningen, The Netherlands
| | - Cisca Wijmenga
- University of Groningen, University Medical Center Groningen, Department of Genetics, 9700 RB Groningen, The Netherlands.
| | - Javier Gutierrez-Achury
- University of Groningen, University Medical Center Groningen, Department of Genetics, 9700 RB Groningen, The Netherlands
| |
Collapse
|
365
|
Schuppan D, Pickert G, Ashfaq-Khan M, Zevallos V. Non-celiac wheat sensitivity: differential diagnosis, triggers and implications. Best Pract Res Clin Gastroenterol 2015; 29:469-76. [PMID: 26060111 DOI: 10.1016/j.bpg.2015.04.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 01/31/2023]
Abstract
Non allergy-non-celiac wheat sensitivity (NCWS) has become a common and often overrated diagnosis. Skepticism mainly relates to patients with prominent intestinal symptoms in the absence of general or intestinal signs of inflammation. There is consensus that the major wheat sensitivities, celiac disease and wheat allergy, have to be ruled out which may be difficult for wheat allergy. The non-inflammatory intolerances to carbohydrates, mainly lactose and FODMAPs (fermentable oligi-, di-, monosaccharides and polyols), which cause bloating or diarrhoea, can usually be excluded clinically or by simple tests. Recent studies and experimental data strongly indicate that NCWS exists in a substantial proportion of the population, that it is an innate immune reaction to wheat and that patients often present with extraintestinal symptoms, such as worsening of an underlying inflammatory disease in clear association with wheat consumption. Wheat amylase-trypsin inhibitors (ATIs) have been identified as the most likely triggers of NCWS. They are highly protease resistant and activate the toll-like receptor 4 (TLR4) complex in monocytes, macrophages and dendritic cells of the intestinal mucosa. Non-gluten containing cereals or staples display no or little TLR4 stimulating activity. Wheat ATIs are a family of up to 17 similar proteins of molecular weights around 15 kD and represent 2-4% of the wheat protein. With oral ingestion they costimulate antigen presenting cells and promote T cell activation in celiac disease, but also in other immune-mediated diseases within and outside the GI tract.
Collapse
Affiliation(s)
- Detlef Schuppan
- Institute for Translational Immunology and Research Center for Immunotherapy (FZI), University Medical Center, Johannes Gutenberg University, Mainz, Germany; Celiac Center, Beth Israel Deaconess Medical Center, and Harvard Celiac Center, Harvard Medical School, Boston, MA, USA.
| | - Geethanjali Pickert
- Institute for Translational Immunology and Research Center for Immunotherapy (FZI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Muhammad Ashfaq-Khan
- Institute for Translational Immunology and Research Center for Immunotherapy (FZI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Victor Zevallos
- Institute for Translational Immunology and Research Center for Immunotherapy (FZI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
366
|
Abstract
Wheat-related disorders have become a growing area of clinical and scientific interest and can be categorized broadly as: autoimmune-mediated; allergic; and non-autoimmune/non-allergic conditions. Non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) present on this spectrum as disorders associated with adverse gastrointestinal and extra-intestinal manifestations following exposure to gluten and/or other wheat-related constituents. NCGS/NCWS is increasingly considered in patients with unexplained symptoms after the exclusions of celiac disease and wheat allergy. As objective diagnostic data and specific biomarkers are lacking, response to a gluten-free/wheat-free diet can confirm the presence of NCGS/NCWS. An association with irritable bowel syndrome has been detected, and the effects of other food components, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, may contribute. Our organization and synthesis of extant knowledge pertaining to wheat-related disorders may advance current practice and research efforts toward an improved understanding of NCGS/NCWS as an evolving clinical entity.
Collapse
Affiliation(s)
- Renée M Marchioni Beery
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1845, USA
| | | |
Collapse
|
367
|
Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE. Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders. Best Pract Res Clin Gastroenterol 2015; 29:477-91. [PMID: 26060112 DOI: 10.1016/j.bpg.2015.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 02/07/2023]
Abstract
Non-celiac gluten sensitivity is an undefined syndrome with gastrointestinal and extra-intestinal manifestations triggered by gluten in patients without celiac disease and wheat allergy. The pathogenesis involves immune-mediated mechanisms requiring further research. Symptoms disappear in a few hours or days after gluten withdrawal and recur rapidly after gluten ingestion. Besides gluten, other wheat proteins as well as fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may contribute to this syndrome. This syndrome occurs mainly in young women, being rare in children. Its prevalence ranges from 0.6% to 6%, based on primary or tertiary care center estimates. No biomarker is available, but half of patients tests positive for IgG anti-gliadin antibodies, which disappear quickly after gluten-free diet together with symptoms. Also, genetic markers are still undefined. Although currently limited to a research setting, double-blind, placebo-controlled, cross-over trial strategy is recommended to confirm the diagnosis. Treatment is based on dietary restriction with special care to nutrient intake.
Collapse
Affiliation(s)
- Umberto Volta
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giacomo Caio
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Roberto De Giorgio
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | | | - Gry Skodje
- Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | - Knut E Lundin
- Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Centre for Immune Regulation, University of Oslo, Oslo, Norway.
| |
Collapse
|
368
|
TNF-α Producing Innate Lymphoid Cells (ILCs) Are Increased in Active Celiac Disease and Contribute to Promote Intestinal Atrophy in Mice. PLoS One 2015; 10:e0126291. [PMID: 25950701 PMCID: PMC4423916 DOI: 10.1371/journal.pone.0126291] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/31/2015] [Indexed: 01/31/2023] Open
Abstract
Innate lymphoid cells (ILCs) are an emerging family of innate hematopoietic cells producing inflammatory cytokines and involved in the pathogenesis of several immune-mediated diseases. The aim of this study was to characterize the tissue distribution of ILCs in celiac disease (CD), a gluten-driven enteropathy, and analyze their role in gut tissue damage. ILC subpopulations were analyzed in lamina propria mononuclear cells (LPMCs) isolated from duodenal biopsies of CD patients and healthy controls (CTR) and jejunal specimens of patients undergoing gastro-intestinal bypass by flow cytometry. Cytokines and Toll-like receptors (TLR) were assessed in ILCs either freshly isolated or following incubation of control LPMC with peptidoglycan, poly I:C, or CpG, the agonists of TLR2, TLR3, or TLR9 respectively, by flow cytometry. The role of ILCs in gut tissue damage was evaluated in a mouse model of poly I:C-driven small intestine atrophy. Although the percentage of total ILCs did not differ between CD patients and CTR, ILCs producing TNF-α and IFN-γ were more abundant in CD mucosa compared to controls. ILCs expressed TLR2, TLR3 and TLR9 but neither TLR7 nor TLR4. Stimulation of LPMC with poly I:C but not PGN or CpG increased TNF-α and IFN-γ in ILCs. RAG1-deficient mice given poly I:C exhibited increased frequency of TNF-α but not IFN-γ/IL17A-producing ILCs in the gut and depletion of ILCs prevented the poly I:C-driven intestinal damage. Our data indicate that CD-related inflammation is marked by accumulation of ILCs producing TNF-α and IFN-γ in the mucosa. Moreover, ILCs express TLR3 and are functionally able to respond to poly I:C with increased synthesis of TNF-α thus contributing to small intestinal atrophy.
Collapse
|
369
|
van Bergen J, Mulder CJ, Mearin ML, Koning F. Local communication among mucosal immune cells in patients with celiac disease. Gastroenterology 2015; 148:1187-94. [PMID: 25623043 DOI: 10.1053/j.gastro.2015.01.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 12/16/2022]
Abstract
In patients with celiac disease, gluten consumption causes inflammation of the duodenum, and, to a lesser extent, the proximal jejunum. Immune-dominant gluten peptides are modified by the enzyme TG2, leading to their high-affinity binding to HLA-DQ2 or HLA-DQ8 molecules, present in people with a predisposition to celiac disease. Gluten peptide-loaded HLA-DQ2 or HLA-DQ8 molecules are recognized by highly conserved receptors on CD4(+) T cells in the lamina propria. B cells specific for TG2 and modified gluten peptides are also abundant in the lamina propria of patients with celiac disease. In the epithelium, interleukin-15 activates intraepithelial lymphocytes that promote destruction of epithelial cells. However, it is not clear how the immune responses in the lamina propria and the epithelium, separated by a basement membrane, are linked. We review the immune processes that occur in the lamina propria and their potential effects on epithelial pathology in celiac disease.
Collapse
Affiliation(s)
- Jeroen van Bergen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Chris J Mulder
- Department of Gastroenterology, Free University Medical Center, Amsterdam, The Netherlands
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Koning
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
370
|
Valenta R, Hochwallner H, Linhart B, Pahr S. Food allergies: the basics. Gastroenterology 2015; 148:1120-31.e4. [PMID: 25680669 PMCID: PMC4414527 DOI: 10.1053/j.gastro.2015.02.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 12/16/2022]
Abstract
IgE-associated food allergy affects approximately 3% of the population and has severe effects on the daily life of patients-manifestations occur not only in the gastrointestinal tract but also affect other organ systems. Birth cohort studies have shown that allergic sensitization to food allergens develops early in childhood. Mechanisms of pathogenesis include cross-linking of mast cell- and basophil-bound IgE and immediate release of inflammatory mediators, as well as late-phase and chronic allergic inflammation, resulting from T-cell, basophil, and eosinophil activation. Researchers have begun to characterize the molecular features of food allergens and have developed chip-based assays for multiple allergens. These have provided information about cross-reactivity among different sources of food allergens, identified disease-causing food allergens, and helped us to estimate the severity and types of allergic reactions in patients. Importantly, learning about the structure of disease-causing food allergens has allowed researchers to engineer synthetic and recombinant vaccines.
Collapse
Affiliation(s)
- Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| | | | | | | |
Collapse
|
371
|
|
372
|
Gibson PR, Varney J, Malakar S, Muir JG. Food components and irritable bowel syndrome. Gastroenterology 2015; 148:1158-74.e4. [PMID: 25680668 DOI: 10.1053/j.gastro.2015.02.005] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
Abstract
Ingestion of food has long been linked with gut symptoms, and there is increasing interest in using diet in the management of patients with irritable bowel syndrome (IBS). The West has developed an intense interest in specialized, restrictive diets, such as those that target multiple food groups, avoid gluten, or reduce fermentable oligo-, di-, and mono-saccharides and polyols. However, most gastroenterologists are not well educated about diets or their effects on the gut. It is important to understand the various dietary approaches, their putative mechanisms, the evidence that supports their use, and the benefits or harm they might produce. The concepts behind, and delivery of, specialized diets differ from those of pharmacologic agents. High-quality research is needed to determine the efficacy of different dietary approaches and the place of specific strategies.
Collapse
Affiliation(s)
- Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.
| | - Jane Varney
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Sreepurna Malakar
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
373
|
Fasano A, Sapone A, Zevallos V, Schuppan D. Nonceliac gluten sensitivity. Gastroenterology 2015; 148:1195-204. [PMID: 25583468 DOI: 10.1053/j.gastro.2014.12.049] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 12/15/2022]
Abstract
During the past decade there has been an impressive increase in popularity of the gluten-free diet (GFD)-now the most trendy alimentary habit in the United States and other countries. According to recent surveys, as many as 100 million Americans will consume gluten-free products within a year. Operating under the concept that the GFD benefits only individuals with celiac disease, health care professionals have struggled to separate the wheat from the chaff; there are claims that eliminating gluten from the diet increases health and helps with weight loss, or even that gluten can be harmful to every human being. However, apart from unfounded trends, a disorder related to ingestion of gluten or gluten-containing cereals, namely nonceliac gluten sensitivity (NCGS), has resurfaced in the literature, fueling a debate on the appropriateness of the GFD for people without celiac disease. Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS. However, we require a better understanding of the clinical presentation of NCGS, as well as its pathogenesis, epidemiology, management, and role in conditions such as irritable bowel syndrome, chronic fatigue, and autoimmunity. Before we can begin to identify and manage NCGS, there must be agreement on the nomenclature and definition of the disorder based on proper peer-reviewed scientific information. We review the most recent findings on NCGS and outline directions to dissipate some of the confusion related to this disorder.
Collapse
Affiliation(s)
- Alessio Fasano
- Mucosal Immunology and Biology Research Center and Center for Celiac Research, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts.
| | - Anna Sapone
- Mucosal Immunology and Biology Research Center and Center for Celiac Research, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Victor Zevallos
- Institute of Translational Immunology and Research Center for Immunotherapy, University of Mainz Medical Center, Mainz, Germany
| | - Detlef Schuppan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Institute of Translational Immunology and Research Center for Immunotherapy, University of Mainz Medical Center, Mainz, Germany
| |
Collapse
|
374
|
Biesiekierski JR, Iven J. Non-coeliac gluten sensitivity: piecing the puzzle together. United European Gastroenterol J 2015; 3:160-5. [PMID: 25922675 DOI: 10.1177/2050640615578388] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 12/11/2022] Open
Abstract
The avoidance of wheat- and gluten-containing products is a worldwide phenomenon. While coeliac disease is well-established, much remains unknown about whether gluten can be a trigger of gastrointestinal and/or extra-intestinal symptoms in patients without coeliac disease. In this article, we discuss the latest scientific evidence and our current understanding for the possible mechanisms of this largely ambiguous group, termed 'non-coeliac gluten sensitive' (NCGS). We can conclude that NCGS should be regarded as an independent disease outside of coeliac disease and wheat allergy, and that the number of patients affected is likely to be limited. Many questions remain unanswered and it needs to be verified whether the elimination of dietary gluten alone is sufficient for the control of symptoms, and to understand the overlap with other components of wheat.
Collapse
Affiliation(s)
| | - Julie Iven
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| |
Collapse
|
375
|
Assessing of Celiac Disease and Nonceliac Gluten Sensitivity. Gastroenterol Res Pract 2015; 2015:723954. [PMID: 26064097 PMCID: PMC4429206 DOI: 10.1155/2015/723954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/15/2015] [Indexed: 12/17/2022] Open
Abstract
The publication of papers on the topic of gluten related disorders has substantially increased over the last few years. This has motivated healthcare professionals to pay attention not only to celiac disease and wheat allergy but also to a condition termed nonceliac gluten sensitivity (NCGS). Until now this condition has been diagnosed clinically on the basis of exclusion criteria and clinical response to gluten withdrawal. In addition, recent research in this field has shown that other food components distinct from gluten are implicated in NCGS cases, thereby changing our general understanding of NCGS diagnosis in either individuals on gluten containing diets or those already following a gluten-free diet with no proper diagnostic work-up of celiac disease. With this in mind, the assessment of NCGS will require extensive knowledge of celiac disease manifestations and the laboratory tests commonly performed during diagnosis of celiac disease.
Collapse
|
376
|
Abstract
While the central role of an adaptive, T cell-mediated immune response to certain gluten peptides in celiac disease is well established, the innate immune response to wheat proteins remains less well defined. We identified wheat amylase trypsin inhibitors (ATIs), but not gluten, as major stimulators of innate immune cells (dendritic cells>macrophages>monocytes), while intestinal epithelial cells were nonresponsive. ATIs bind to and activate the CD14-MD2 toll-like receptor 4 (TLR4) complex. This activation occurs both in vitro and in vivo after oral ingestion of purified ATIs or gluten, which is usually enriched in ATIs. Wheat ATIs represent a family of up to 17 proteins with molecular weights of around 15 kDa and a variable primary but conserved secondary structure characterized by 5 intrachain disulfide bonds and alpha helices. They mostly form di- and tetramers that appear to equally activate TLR4. Relevant biological activity is confined to ATIs in gluten-containing cereals, while gluten-free cereals display no or minimal activities. ATIs represent up to 4% of total wheat protein and are highly resistant to intestinal proteases. In line with their dose-dependent function as co-stimulatory molecules in adaptive immunity of celiac disease, they appear to play a role in promoting other immune-mediated diseases within and outside the GI tract. Thus, ATIs may be prime candidates of severe forms of non-celiac gluten (wheat) sensitivity.
Collapse
|
377
|
Abstract
BACKGROUND Celiac disease (CD) results from an alteration in the oral tolerance to dietary gluten. The response to gluten is normally tightly regulated and involves the secretion of TGF-β and IL-10 from different subtypes of regulatory T cells (Tregs). Interestingly, in addition to proinflammatory cytokines, the inflamed CD mucosa also contains high levels of T cell-derived IL-10 compared with treated CD patients or normal donors. Furthermore, most studies describe an increase in the number of Foxp3+ Tregs in the small intestinal mucosa in CD patients compared to controls. This paradoxical condition suggests that regulatory mechanisms might operate to counterbalance the abnormal gliadin-triggered immune activation in untreated mucosa. Indeed, addition of exogenous IL-10 to mucosal cultures from treated CD patients can suppress gliadin-induced T cell activation. Considering the central role of adaptive immunity in CD, the development of strategies to stimulate these mechanisms is a primary goal of efforts to restore gluten tolerance. Key Messages: Different immunomodulatory strategies have been explored. NexVax2, a desensitizing vaccine that uses three dominant gluten peptides administered subcutaneously to induce a tolerogenic response in CD patients, is under development. Alternatively, the potential of substituted, cyclic or dimeric peptide analogues as blockers to prevent HLA from binding to the immunodominant gliadin epitopes has been demonstrated in vitro. In line with these results, we recently found that modified (transamidated) gliadins influenced the immune response in intestinal biopsy samples from CD patients with overt disease by drastically reducing the production of IFN-γ. Notably, in a mouse model, transamidated gliadins reverted the phenotype of the gliadin-inducible immune response from an inflammatory phenotype to an anti-inflammatory phenotype. CONCLUSIONS Various approaches are currently under investigation to recover gluten tolerance based on the use of both modified and native antigen molecules. More specific studies are now required to test the efficacy of such strategies for preventing CD.
Collapse
Affiliation(s)
- Mauro Rossi
- Institute of Food Sciences, CNR, Avellino, Italy
| |
Collapse
|
378
|
Abstract
BACKGROUND While it is well documented and widely appreciated that ingestion of wheat (and less so rye and barley) is associated with gastrointestinal symptoms such as bloating or abdominal pain, the component of wheat to which such an effect is attributed is less well established. KEY MESSAGES Wheat is a complex of proteins (80% gluten, 20% metabolic proteins), carbohydrates (starch, non-starch polysaccharides, fructans), lipids and other components. The majority of attention has focused on gluten as the culprit in triggering symptoms, but re-challenge studies have nearly all used wheat flour-related products (such as bread) as the stimulus. When carbohydrate-deplete gluten was used as the challenge agent, gluten-specific feelings of depression and not gut symptoms were observed in those who fulfilled strict criteria of 'non-coeliac gluten sensitivity', thereby underlining the complexity of cereals and of undertaking research in this area. Candidate components other than gluten include poorly absorbed oligosaccharides (mainly fructans), non-gluten wheat proteins such as amylase-trypsin inhibitors or wheat germ agglutinin, and exorphins released during the digestion of gluten. Specific biological and/or clinical effects associated with gluten-free diets or wheat ingestion need to be carefully dissected before attribution to gluten can be claimed. CONCLUSIONS Currently, coeliac disease is the only common condition that has been unequivocally linked to gluten. Inaccurate attribution will be associated with suboptimal therapeutic advice and at least partly underlies the current gluten-free epidemic gripping the Western world.
Collapse
|
379
|
Picariello G, Mamone G, Cutignano A, Fontana A, Zurlo L, Addeo F, Ferranti P. Proteomics, peptidomics, and immunogenic potential of wheat beer (Weissbier). JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:3579-3586. [PMID: 25793656 DOI: 10.1021/acs.jafc.5b00631] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Wheat beer is a traditional light-colored top-fermenting beer brewed with at least 50% malted (e.g., German Weissbier) or unmalted (e.g., Belgian Witbier) wheat (Triticum aestivum) as an adjunct to barley (Hordeum vulgare) malt. For the first time, we explored the proteome of three Weissbier samples, using both 2D electrophoresis (2DE)-based and 2DE-free strategies. Overall, 58 different gene products arising from barley, wheat, and yeast (Saccharomyces spp.) were identified in the protein fraction of a representative Weissbier sample analyzed in detail. Analogous to all-barley-malt beers (BMB), barley and wheat Z-type serpins and nonspecific lipid transfer proteins dominated the proteome of Weissbier. Several α-amylase/trypsin inhibitors also survived the harsh brewing conditions. During brewing, hundreds of peptides are released into beer. By liquid chromatography-electrospray tandem mass spectrometry (LC-ESI MS/MS) analysis, we characterized 167 peptides belonging to 44 proteins, including gliadins, hordeins, and high- and low-molecular-weight glutenin subunits. Because of the interference from the overabundant yeast-derived peptides, we identified only a limited number of epitopes potentially triggering celiac disease. However, Weissbier samples contained 374, 372, and 382 ppm gliadin-equivalent peptides, as determined with the competitive G12 ELISA, which is roughly 10-fold higher than a lager BMB (41 ppm), thereby confirming that Weissbier is unsuited for celiacs. Western blot analysis demonstrated that Weissbier also contained large-sized prolamins immunoresponsive to antigliadin IgA antibodies from the pooled sera of celiac patients (n = 4).
Collapse
Affiliation(s)
- Gianluca Picariello
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, Via Roma 64, I-83100 Avellino, Italy
| | - Gianfranco Mamone
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, Via Roma 64, I-83100 Avellino, Italy
| | - Adele Cutignano
- ‡Istituto di Chimica Biomolecolare, Consiglio Nazionale delle Ricerche, Via Campi Flegrei 34, I-80078 Pozzuoli (Napoli), Italy
| | - Angelo Fontana
- ‡Istituto di Chimica Biomolecolare, Consiglio Nazionale delle Ricerche, Via Campi Flegrei 34, I-80078 Pozzuoli (Napoli), Italy
| | - Lucia Zurlo
- §Dipartimento di Agraria, Università di Napoli "Federico II", Parco Gussone, I-80055 Portici (Napoli), Italy
| | - Francesco Addeo
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, Via Roma 64, I-83100 Avellino, Italy
| | - Pasquale Ferranti
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, Via Roma 64, I-83100 Avellino, Italy
- §Dipartimento di Agraria, Università di Napoli "Federico II", Parco Gussone, I-80055 Portici (Napoli), Italy
| |
Collapse
|
380
|
A study evaluating the bidirectional relationship between inflammatory bowel disease and self-reported non-celiac gluten sensitivity. Inflamm Bowel Dis 2015; 21:847-53. [PMID: 25719528 DOI: 10.1097/mib.0000000000000335] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Non-celiac gluten sensitivity and the associated use of a gluten-free diet (GFD) are perceived to belong to the spectrum of irritable bowel syndrome (IBS). However, recent reports suggest substantial use of a GFD in inflammatory bowel disease (IBD). We assessed the bidirectional relationship between IBD and self-reported non-celiac gluten sensitivity (SR-NCGS). METHODS A cross-sectional questionnaire screened for SR-NCGS and the use of a GFD in 4 groups: ulcerative colitis (n = 75), Crohn's disease (n = 70), IBS (n = 59), and dyspeptic controls (n = 109). We also assessed diagnostic outcomes for IBD in 200 patients presenting with SR-NCGS. RESULTS The prevalence of SR-NCGS was 42.4% (n = 25/59) for IBS, followed by 27.6% (n = 40/145) for IBD, and least among dyspeptic controls at 17.4% (n = 19/109); P = 0.015. The current use of a GFD was 11.9% (n = 7/59) for IBS, 6.2% (n = 9/145) for IBD, and 0.9% (1/109) for dyspeptic controls; P = 0.02. No differences were established between ulcerative colitis and Crohn's disease. However, Crohn's disease patients with SR-NCGS were significantly more likely to have stricturing disease (40.9% versus 18.9%, P = 0.046), and higher mean Crohn's Disease Activity Index score (228.1 versus 133.3, P = 0.002), than those without SR-NCGS. Analysis of 200 cases presenting with SR-NCGS suggested that 98.5% (n = 197) could be dietary-related IBS. However, 1.5% (n = 3) were found to have IBD; such patients had associated alarm symptoms, and/or abnormal blood parameters, prompting colonic investigations. CONCLUSIONS SR-NCGS is not only exclusive to IBS but also associated with IBD, where its presence may be reflecting severe or stricturing disease. Randomized studies are required to further delineate the nature of this relationship and clarify whether a GFD is a valuable dietetic intervention in selected IBD patients.
Collapse
|
381
|
Abstract
The spectrum of gluten-related disorders was restricted to coeliac disease and wheat allergy, but the new contemporary entity referred to as noncoeliac gluten sensitivity has gained recognition mainly in adults but also in children. Noncoeliac gluten sensitivity is defined as the presence of a variety of symptoms related to gluten ingestion in patients in whom coeliac disease and wheat allergy have been excluded. The pathophysiology and biomarkers of coeliac disease and wheat allergy are well known, but this is not the case for noncoeliac gluten sensitivity. It is also not clear whether noncoeliac gluten sensitivity is caused by consumption of gluten or by consumption of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Randomized trials on noncoeliac gluten sensitivity in children are lacking and are hardly needed to evaluate its role in paediatric patients with gastroenterology to avoid the use of unnecessary restrictive diets in children and interference with proper diagnosis of coeliac disease.
Collapse
|
382
|
Guandalini S, Polanco I. Nonceliac gluten sensitivity or wheat intolerance syndrome? J Pediatr 2015; 166:805-11. [PMID: 25662287 DOI: 10.1016/j.jpeds.2014.12.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/24/2014] [Accepted: 12/16/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL.
| | - Isabel Polanco
- Autonomous University, La Paz Children's University Hospital, Madrid, Spain
| |
Collapse
|
383
|
Mamone G, Nitride C, Picariello G, Addeo F, Ferranti P, Mackie A. Tracking the fate of pasta (T. Durum semolina) immunogenic proteins by in vitro simulated digestion. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:2660-2667. [PMID: 25682706 DOI: 10.1021/jf505461x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to identify and characterize the celiacogenic/immunogenic proteins and peptides released during digestion of pasta (Triticum durum semolina). Cooked pasta was digested using a harmonized in vitro static model of oral-gastro-duodenal digestion. The course of pasta protein digestion was monitored by SDS-PAGE, and gluten proteins were specifically analyzed by Western blot using sera of celiac patients. Among the allergens, nonspecific lipid-transfer protein was highly resistant to gastro-duodenal hydrolysis, while other digestion-stable allergens such as α-amylase/trypsin inhibitors were not detected being totally released in the pasta cooking water. To simulate the final stage of intestinal degradation, the gastro-duodenal digesta were incubated with porcine jejunal brush-border membrane hydrolases. Sixty-one peptides surviving the brush-border membrane peptidases were identified by liquid chromatography-mass spectrometry, including several gluten-derived sequences encrypting different motifs responsible for the induction of celiac disease. These results provide new insights into the persistence of wheat-derived peptides during digestion of cooked pasta samples.
Collapse
Affiliation(s)
- Gianfranco Mamone
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, via Roma 64, 83100 Avellino, Italy
| | - Chiara Nitride
- ‡Dipartimento di Agraria, Università Federico II, via Università 100, 80055 Portici, Napoli, Italy
| | - Gianluca Picariello
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, via Roma 64, 83100 Avellino, Italy
| | - Francesco Addeo
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, via Roma 64, 83100 Avellino, Italy
- ‡Dipartimento di Agraria, Università Federico II, via Università 100, 80055 Portici, Napoli, Italy
| | - Pasquale Ferranti
- †Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, via Roma 64, 83100 Avellino, Italy
- ‡Dipartimento di Agraria, Università Federico II, via Università 100, 80055 Portici, Napoli, Italy
| | - Alan Mackie
- §Institute of Food Research, Norwich Research Park, Norwich, Norfolk NR4 7UA, United Kingdom
| |
Collapse
|
384
|
Slot IDB, van der Fels-Klerx HJ, Bremer MGEG, Hamer RJ. Immunochemical Detection Methods for Gluten in Food Products: Where Do We Go from Here? Crit Rev Food Sci Nutr 2015; 56:2455-2466. [DOI: 10.1080/10408398.2013.847817] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
385
|
Larsen J, Weile C, Antvorskov JC, Engkilde K, Nielsen SMB, Josefsen K, Buschard K. Effect of dietary gluten on dendritic cells and innate immune subsets in BALB/c and NOD mice. PLoS One 2015; 10:e0118618. [PMID: 25738288 PMCID: PMC4349814 DOI: 10.1371/journal.pone.0118618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/21/2015] [Indexed: 12/13/2022] Open
Abstract
The innate immune system is known to play an important role in oral tolerance to dietary antigens. This is important in development of celiac disease (CD) but may also be important in type 1 diabetes (T1D), and could potentially explain the reduced incidence of T1D in mice receiving a gluten-free (GF) diet. The direct in vivo effect of gluten on innate cells, and particularly dendritic cells (DC) is not sufficiently clarified. Therefore, we wished to investigate the innate cell populations of spontaneous diabetic NOD mice and healthy BALB/c mice kept on a GF or a standard (STD) gluten containing diet. We studied, by flow cytometry and reverse transcription-quantitative polymerase chain reaction (qRT-PCR), if dietary gluten induces changes in the activation of DCs and distribution of selected innate cells in lymphoid, pancreatic and intestinal tissues in BALB/c and NOD mice. We found that a GF diet increased the percentage of macrophages in BALB/c spleen and of CD11c+ DCs in BALB/c and NOD spleen. Strictly gluten-free (SGF) diet increased the percentage of CD103+ DCs in BALB/c mice and decreased percentages of CD11b+ DCs in mesenteric and pancreatic lymph nodes in BALB/c mice. SGF diet in BALB/c mice also decreased DC expression of CD40, CCR7 and MHC-II in pancreatic lymph nodes. In conclusion, GF diet changes the composition of the innate immune system in BALB/c and NOD mice and increases expression of DC activation markers in NOD mice. These results contribute to the explanation of the low diabetes incidence in GF NOD mice. This mechanism may be important in development of type 1 diabetes, celiac disease and non-celiac gluten sensitivity.
Collapse
Affiliation(s)
- Jesper Larsen
- The Bartholin Institute, Rigshospitalet, 2100, Copenhagen, Denmark
- * E-mail:
| | - Christian Weile
- The Bartholin Institute, Rigshospitalet, 2100, Copenhagen, Denmark
| | | | - Kåre Engkilde
- The Bartholin Institute, Rigshospitalet, 2100, Copenhagen, Denmark
| | | | - Knud Josefsen
- The Bartholin Institute, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Karsten Buschard
- The Bartholin Institute, Rigshospitalet, 2100, Copenhagen, Denmark
| |
Collapse
|
386
|
Carroccio A, D'Alcamo A, Mansueto P. Nonceliac wheat sensitivity in the context of multiple food hypersensitivity: new data from confocal endomicroscopy. Gastroenterology 2015; 148:666-7. [PMID: 25625764 DOI: 10.1053/j.gastro.2014.11.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/06/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Antonio Carroccio
- Internal Medicine, Giovanni Paolo II Hospital, Sciacca (AG) and University of Palermo, Palermo, Italy
| | - Alberto D'Alcamo
- Internal Medicine, Department Di.Bi.M.I.S., University Hospital of Palermo, Palermo, Italy
| | - Pasquale Mansueto
- Internal Medicine, Department Di.Bi.M.I.S., University Hospital of Palermo, Palermo, Italy
| |
Collapse
|
387
|
Fritscher-Ravens A. Reply: To PMID 25083606. Gastroenterology 2015; 148:667. [PMID: 25659763 DOI: 10.1053/j.gastro.2015.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Annette Fritscher-Ravens
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
388
|
Kucek LK, Veenstra LD, Amnuaycheewa P, Sorrells ME. A Grounded Guide to Gluten: How Modern Genotypes and Processing Impact Wheat Sensitivity. Compr Rev Food Sci Food Saf 2015; 14:285-302. [PMID: 33401796 DOI: 10.1111/1541-4337.12129] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/04/2015] [Indexed: 12/30/2022]
Abstract
The role of wheat, and particularly of gluten protein, in our diet has recently been scrutinized. This article provides a summary of the main pathologies related to wheat in the human body, including celiac disease, wheat allergy, nonceliac wheat sensitivity, fructose malabsorption, and irritable bowel syndrome. Differences in reactivity are discussed for ancient, heritage, and modern wheats. Due to large variability among species and genotypes, it might be feasible to select wheat varieties with lower amounts and fewer types of reactive prolamins and fructans. Einkorn is promising for producing fewer immunotoxic effects in a number of celiac research studies. Additionally, the impact of wheat processing methods on wheat sensitivity is reviewed. Research indicates that germination and fermentation technologies can effectively alter certain immunoreactive components. For individuals with wheat sensitivity, less-reactive wheat products can slow down disease development and improve quality of life. While research has not proven causation in the increase in wheat sensitivity over the last decades, modern wheat processing may have increased exposure to immunoreactive compounds. More research is necessary to understand the influence of modern wheat cultivars on epidemiological change.
Collapse
Affiliation(s)
- Lisa Kissing Kucek
- School of Integrated Plant Science, Plant Breeding and Genetics Section, 240 Emerson Hall, Cornell Univ., Ithaca, NY, 14853, U.S.A
| | - Lynn D Veenstra
- School of Integrated Plant Science, Plant Breeding and Genetics Section, 240 Emerson Hall, Cornell Univ., Ithaca, NY, 14853, U.S.A
| | - Plaimein Amnuaycheewa
- Dept. of Agro-Industrial, Food, and Environmental Technology, Faculty of Applied Science, King Mongkut's Univ. of Technology North Bangkok, Bangkok, 10800, Thailand
| | - Mark E Sorrells
- School of Integrated Plant Science, Plant Breeding and Genetics Section, 240 Emerson Hall, Cornell Univ., Ithaca, NY, 14853, U.S.A
| |
Collapse
|
389
|
Abstract
Mankind has existed for 2·5 million years but only in the last 10 000 years have we been exposed to wheat. Wheat was first cultivated in the Fertile Crescent (South Western Asia) with a farming expansion that lasted from about 9000BC to 4000BC. Thus it could be considered that wheat (and gluten) is a novel introduction to man's diet! Prior to 1939 the rationing system had already been devised. This led to an imperative to try to increase agricultural production. Thus it was agreed in 1941 that there was a need to establish a Nutrition Society. The very roots of the society were geared towards necessarily increasing the production of wheat. This goal was achieved and by the end of the 20th century, global wheat output had expanded 5-fold. Perhaps as a result the epidemiology of coeliac disease (CD) or gluten sensitive enteropathy has changed. CD is a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals. CD now affects 1 % or more of all adults, for which the treatment is a strict lifelong gluten-free diet. However, there is a growing body of evidence to show that a far greater proportion of individuals without coeliac disease are taking a gluten-free diet of their own volition. This clinical entity has been termed non-coeliac gluten sensitivity (NCGS), although the condition is fraught with complexities due to overlap with other gluten-based constituents that can also trigger similar clinical symptoms. This review will explore the relationship between gluten, the rising prevalence of modern coeliac disease, and the new entity of NCGS along with its associated uncertainties.
Collapse
|
390
|
Schuppan D, Zimmer KP. The diagnosis and treatment of celiac disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:835-46. [PMID: 24355936 DOI: 10.3238/arztebl.2013.0835] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Celiac disease is an inflammatory disease of, the small intestine with a prevalence of roughly 0.5%-1%. Its symptoms arise in response to gluten consumption by genetically predisposed persons (HLA-DQ2/8). The autoantigen tissue transglutaminase (TG2) plays an important role in the pathogenesis of celiac disease. METHOD Selective review of pertinent literature, including guidelines from Germany and abroad. RESULTS Celiac disease can present at any age with gastrointestinal or extraintestinal manifestations (e.g., malabsorption or Duhring's dermatitis herpetiformis); it can also be found in association with other (auto-)immune diseases, such as type 1 diabetes. Most cases are oligosymptomatic. The wide differential diagnosis includes food intolerances, intestinal infections, and irritable bowel syndrome, among other conditions. The definitive diagnosis requires the demonstration of celiac disease-specific autoantibody to TG2 (endomysium), which is over 90% sensitive and far over 90% specific, and the characteristic histologic lesions of the small-bowel mucosa and remission on a gluten-free diet. CONCLUSION An understanding of celiac disease ought to inform everyday clinical practice in all medical disciplines, because this is a common condition with diverse manifestations that can be effectively diagnosed and easily treated for the prevention of both acute and long-term complications. Patients should follow a strictly gluten-free diet for life.
Collapse
Affiliation(s)
- Detlef Schuppan
- Institute of Translational Immunology, Johannes Gutenberg University, Mainz, and Division of Gastroenterology, Beth Israel deaconess Medical Center, Harvard Medical School, Boston, MA, USA, Center for Pediatric and Adolescent Medicine, Justus Liebig University, Gießen
| | | |
Collapse
|
391
|
Assandri R, Monari M, Colombo A, Montanelli A. Innate immune system: the no man's land where discover new biomarkers for gluten-related-disorders. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:95-8. [PMID: 25926933 PMCID: PMC4403021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
392
|
Abadie V, Jabri B. Immunopathology of Celiac Disease. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
393
|
Korneychuk N, Meresse B, Cerf-Bensussan N. Lessons from rodent models in celiac disease. Mucosal Immunol 2015; 8:18-28. [PMID: 25354320 DOI: 10.1038/mi.2014.102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/23/2014] [Indexed: 02/04/2023]
Abstract
Over the past 25 years, studies led in humans have considerably improved our understanding of celiac disease, a complex disease that is generally defined as an autoimmune-like enteropathy induced by dietary gluten in genetically predisposed individuals. Recently, large efforts were also invested in the development of mouse models in order to explore pathogenic hypotheses, and also with the goal to design pretherapeutic models that could be used to test innovative therapies. Yet, modeling this complex multifactorial disease has been a very challenging task. Herein, we review how approaches in rodents have provided insight into celiac disease pathophysiology and also highlight the difficulties met to fully recapitulate the human disease.
Collapse
Affiliation(s)
- N Korneychuk
- 1] INSERM UMR1163, Laboratory of Intestinal Immunity, Institut Imagine, Paris, France [2] Université Paris Descartes-Sorbonne Paris Cité and Institut Imagine, Paris, France
| | - B Meresse
- 1] INSERM UMR1163, Laboratory of Intestinal Immunity, Institut Imagine, Paris, France [2] Université Paris Descartes-Sorbonne Paris Cité and Institut Imagine, Paris, France
| | - N Cerf-Bensussan
- 1] INSERM UMR1163, Laboratory of Intestinal Immunity, Institut Imagine, Paris, France [2] Université Paris Descartes-Sorbonne Paris Cité and Institut Imagine, Paris, France
| |
Collapse
|
394
|
Rostami K, Rostami-Nejad M, Al Dulaimi D. Post gastroenteritis gluten intolerance. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:66-70. [PMID: 25584178 PMCID: PMC4285934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/24/2014] [Indexed: 11/05/2022]
|
395
|
Carroccio A, Soresi M, D’Alcamo A, Sciumè C, Iacono G, Geraci G, Brusca I, Seidita A, Adragna F, Carta M, Mansueto P. Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC Med 2014; 12:230. [PMID: 25430806 PMCID: PMC4265355 DOI: 10.1186/s12916-014-0230-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/07/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-celiac gluten sensitivity (NCGS) or 'wheat sensitivity' (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics. METHODS This prospective observation study included 75 NCWS patients (63 women; median age 36 years) with irritable bowel syndrome (IBS)-like symptoms, 65 IBS and 50 celiac controls. Patients were recruited at two Internal Medicine Departments. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, HLA DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake. RESULTS DBPC cow's milk proteins challenge showed that 30 of the 75 NCWS patients suffered from multiple food sensitivity. Osteopenia and osteoporosis frequency increased from IBS to NCWS and to celiac disease (CD) (P <0.0001). Thirty-five NCWS patients (46.6%) showed osteopenia or osteoporosis. Low BMD was related to low BMI and multiple food sensitivity. Values of daily dietary calcium intake in NCWS patients were significantly lower than in IBS controls. CONCLUSIONS An elevated frequency of bone mass loss in NCWS patients was found; this was related to low BMI and was more frequent in patients with NCWS associated with other food sensitivity. A low daily intake of dietary calcium was observed in patients with NCWS.
Collapse
Affiliation(s)
- Antonio Carroccio
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
- />Department of Internal Medicine, Giovanni Paolo II Hospital, Via Pompei, Sciacca, Italy
| | - Maurizio Soresi
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| | - Alberto D’Alcamo
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| | - Carmelo Sciumè
- />Department of Surgery, Oncology, and Odontology, University of Palermo, Via L. Giuffrè 5, Palermo, Italy
| | - Giuseppe Iacono
- />Pediatric Gastroenterology, Di Cristina Hospital Palermo, Piazza P. Montalto 2, Palermo, Italy
| | - Girolamo Geraci
- />Department of Surgery, Oncology, and Odontology, University of Palermo, Via L. Giuffrè 5, Palermo, Italy
| | - Ignazio Brusca
- />Department of Pathology, Buccheri - La Ferla Hospital Palermo, Via Messina Marine 197, Palermo, Italy
| | - Aurelio Seidita
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| | - Floriana Adragna
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| | - Miriam Carta
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| | - Pasquale Mansueto
- />Department of Internal Medicine, University Hospital of Palermo, Via del Vespro 141, Palermo, Italy
| |
Collapse
|
396
|
Huebener S, Tanaka CK, Uhde M, Zone JJ, Vensel WH, Kasarda DD, Beams L, Briani C, Green PHR, Altenbach SB, Alaedini A. Specific nongluten proteins of wheat are novel target antigens in celiac disease humoral response. J Proteome Res 2014; 14:503-11. [PMID: 25329597 PMCID: PMC4285749 DOI: 10.1021/pr500809b] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
![]()
While
the antigenic specificity and pathogenic relevance of immunologic
reactivity to gluten in celiac disease have been extensively researched,
the immune response to nongluten proteins of wheat has not been characterized.
We aimed to investigate the level and molecular specificity of antibody
response to wheat nongluten proteins in celiac disease. Serum samples
from patients and controls were screened for IgG and IgA antibody
reactivity to a nongluten protein extract from the wheat cultivar Triticum aestivum Butte 86. Antibodies were
further analyzed for reactivity to specific nongluten proteins by
two-dimensional gel electrophoresis and immunoblotting. Immunoreactive
molecules were identified by tandem mass spectrometry. Compared with
healthy controls, patients exhibited significantly higher levels of
antibody reactivity to nongluten proteins. The main immunoreactive
nongluten antibody target proteins were identified as serpins, purinins,
α-amylase/protease inhibitors, globulins, and farinins. Assessment
of reactivity toward purified recombinant proteins further confirmed
the presence of antibody response to specific antigens. The results
demonstrate that, in addition to the well-recognized immune reaction
to gluten, celiac disease is associated with a robust humoral response
directed at a specific subset of the nongluten proteins of wheat.
Collapse
Affiliation(s)
- Sina Huebener
- Department of Medicine, Columbia University , New York, New York 10032, United States
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
397
|
Gliadin peptides as triggers of the proliferative and stress/innate immune response of the celiac small intestinal mucosa. Int J Mol Sci 2014. [PMID: 25387079 DOI: 10.3390/ijms151120518.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Celiac disease (CD) is a frequent inflammatory intestinal disease, with a genetic background, caused by gliadin-containing food. Undigested gliadin peptides induce innate and adaptive T cell-mediated immune responses. The major mediator of the stress and innate immune response to gliadin peptides (i.e., peptide 31-43, P31-43) is the cytokine interleukin-15 (IL-15). The role of epithelial growth factor (EGF) as a mediator of enterocyte proliferation and the innate immune response has been described. In this paper, we review the most recent literature on the mechanisms responsible for triggering the up-regulation of these mediators in CD by gliadin peptides. We will discuss the role of P31-43 in enterocyte proliferation, structural changes and the innate immune response in CD mucosa in cooperation with EGF and IL-15, and the mechanism of up-regulation of these mediators related to vesicular trafficking. We will also review the literature that focuses on constitutive alterations of the structure, signalling/proliferation and stress/innate immunity pathways of CD cells. Finally, we will discuss how these pathways can be triggered by gliadin peptide P31-43 in controls, mimicking the celiac cellular phenotype.
Collapse
|
398
|
Barone MV, Troncone R, Auricchio S. Gliadin peptides as triggers of the proliferative and stress/innate immune response of the celiac small intestinal mucosa. Int J Mol Sci 2014; 15:20518-37. [PMID: 25387079 PMCID: PMC4264181 DOI: 10.3390/ijms151120518] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a frequent inflammatory intestinal disease, with a genetic background, caused by gliadin-containing food. Undigested gliadin peptides induce innate and adaptive T cell-mediated immune responses. The major mediator of the stress and innate immune response to gliadin peptides (i.e., peptide 31–43, P31–43) is the cytokine interleukin-15 (IL-15). The role of epithelial growth factor (EGF) as a mediator of enterocyte proliferation and the innate immune response has been described. In this paper, we review the most recent literature on the mechanisms responsible for triggering the up-regulation of these mediators in CD by gliadin peptides. We will discuss the role of P31–43 in enterocyte proliferation, structural changes and the innate immune response in CD mucosa in cooperation with EGF and IL-15, and the mechanism of up-regulation of these mediators related to vesicular trafficking. We will also review the literature that focuses on constitutive alterations of the structure, signalling/proliferation and stress/innate immunity pathways of CD cells. Finally, we will discuss how these pathways can be triggered by gliadin peptide P31–43 in controls, mimicking the celiac cellular phenotype.
Collapse
Affiliation(s)
- Maria Vittoria Barone
- Department of Translational Medical Science (Section of Pediatrics), University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy.
| | - Riccardo Troncone
- Department of Translational Medical Science (Section of Pediatrics), University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy.
| | - Salvatore Auricchio
- European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy.
| |
Collapse
|
399
|
Fritscher-Ravens A, Schuppan D, Ellrichmann M, Schoch S, Röcken C, Brasch J, Bethge J, Böttner M, Klose J, Milla PJ. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology 2014; 147:1012-20.e4. [PMID: 25083606 DOI: 10.1053/j.gastro.2014.07.046] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/06/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated suspected food intolerances in patients with irritable bowel syndrome (IBS) using confocal laser endomicroscopy (CLE) for real-time visualization of structural/functional changes in the intestinal mucosa after food challenge. Patients with functional changes after food challenge (CLE+) were placed on personalized exclusion diets and followed up for long-term symptom relief. METHODS Thirty-six IBS patients with suspected food intolerance and 10 patients with Barrett's esophagus (controls) without IBS symptoms were examined by CLE at University Hospital Schleswig-Holstein (Kiel, Germany). Diluted food antigens were administered directly to the duodenal mucosa through the working channel of the endoscope. Epithelial breaks, intervillous spaces, and the number of intraepithelial lymphocytes (IEL) were measured before and after the food challenge. CLE+ patients were placed on exclusion diets, given symptom score questionnaires, and followed up for 1 year; controls resumed their previous diet. RESULTS CLE showed a real-time response to food antigens in 22 of 36 patients; no responses were observed in 14 of 36 patients (CLE-) or any of the controls. Baseline IELs were significantly higher in CLE+ than CLE- subjects (P = .004); numbers increased significantly after food challenge (P = .0008). Within 5 minutes of exposure of CLE+ patients to food antigens, IELs increased, epithelial leaks/gaps formed, and intervillous spaces widened. Epithelial leaks and intervillous spaces also increased significantly in CLE+ vs baseline (both P < .001). The concordance of IELs measured by CLE and conventional histology was 70.6%; they did not correlate (P = .89; r(2) = 0.027). Symptom scores improved more than 50% in CLE+ patients after a 4-week exclusion diet and increased to 74% at 12 months; symptoms continued in CLE- patients. CONCLUSIONS Based on CLE analysis of IBS patients with a suspected food intolerance, exposure to candidate food antigens caused immediate breaks, increased intervillous spaces, and increased IELs in the intestinal mucosa. These changes are associated with patient responses to exclusion diets. Registered at clinicaltrials.gov (registration number: NCT01692613).
Collapse
Affiliation(s)
- Annette Fritscher-Ravens
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Detlef Schuppan
- Institute of Translational Immunology, Department of Medicine I, University of Mainz, Mainz, Germany; Research Center for Immunology, University of Mainz, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Mark Ellrichmann
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stefan Schoch
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jochen Brasch
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johannes Bethge
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Martina Böttner
- Department of Anatomy, Christian Albrecht University, Kiel, Germany
| | - Julius Klose
- Unit of Experimental Endoscopy, Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter J Milla
- University College London Institute of Child Health, University College London, London, United Kingdom
| |
Collapse
|
400
|
Change in awareness of gluten-related disorders among chefs and the general public in the UK: a 10-year follow-up study. Eur J Gastroenterol Hepatol 2014; 26:1228-33. [PMID: 25144492 DOI: 10.1097/meg.0000000000000166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND OBJECTIVES In view of the increasing popularity of a gluten-free diet, we sought to determine whether there has been a change in awareness of gluten-related disorders (GRD) among the general public and chefs. MATERIALS AND METHODS A face-to-face questionnaire on coeliac disease (CD) and gluten sensitivity (GS) was performed on the general public and chefs based in Sheffield, UK. The assessment was first carried out in 2003 and repeated in 2013. RESULTS In total, 513 public members in 2003 (mean age 49.2 years, 62% women) were compared with 575 public members in 2013 (mean age 37.8 years, 57% women). There was a significant increase in the public's awareness of GRD from the years 2003 to 2013, CD [44.2% to 74.4%, adjusted odds ratio (AOR) 3.9; 95% confidence interval (CI) 3.0-5.19] and GS (58.3% to 89%, AOR 7.1; 95% CI 5.0-9.98; P<0.001). Also, 322 chefs in 2003 (mean age 37.6 years, 15% women) were compared with 265 chefs in 2013 (mean age 27.1 years, 38% women). There was a significant increase in chefs' awareness of GRD from the years 2003 to 2013, CD (17.1% to 78.1%, AOR 12.5; 95% CI 7.9-19.6) and GS (9.3% to 87.5%, AOR 65.7; 95% CI 35.4-122; P<0.001). Whereas in 2003 the public were significantly more aware of GRD than chefs, by 2013, this had reached a similar prevalence in both groups. In addition, the correct recognition of the gluten-free symbol was 44% for the public and 40% for chefs (P=0.28). Gluten-free products were sold by 41% of restaurants and 27% of takeaways (P=0.07). CONCLUSION There has been a marked increase in both the public's and chefs' awareness of GRD. Such findings may ease the social phobia that individuals with GRD have traditionally been accustomed to.
Collapse
|