Coeliac disease: a diverse clinical syndrome caused by intolerance of wheat, barley and rye

Validated multiplex-competitive ELISA using gluten-incurred yogurt calibrant for the quantitation of wheat gluten in fermented dairy products

Currently, there are no available methods for accurate quantitation of gluten in fermented or hydrolyzed foods. In this study, gluten-incurred yogurt was used as a calibrant with a multiplex-competitive ELISA to quantitate gluten in fermented dairy products such as yogurt, kefir, and buttermilk, followed by a single-laboratory validation of the method. Four-parameter logistic calibration curves using five gluten-specific antibodies (R5, G12, 2D4, MIoBS, and Skerrit) were constructed, and averaging of the antibody responses was used as a strategy to get a single quantitative value. The lower limits of detection (LLOD) and quantitation (LLOQ) of the method were 1.9 and 5.5 µg/mL (ppm), respectively. Analysis of wheat gluten-incurred fermented dairy products (5, 8, 20, 100, and 500 µg/mL) prepared with multiple starter cultures and fermented for 24 or 48 h resulted in average gluten recoveries of 69-165%, 57-167%, and 54-148% for yogurt, kefir, and buttermilk, respectively. Only a few samples exceeded 150% recovery. The average coefficient of variation (CV) ranged from 10 to 34%, with the majority of the samples having a CV of < 30%. Experimental variations such as long-term refrigerated storage, spiking gluten after initial fermentation, using higher than recommended starter culture concentrations, or using wheat flour for contamination resulted in acceptable gluten recovery (50-150%) for the majority of the samples. Comparison of the performance of this method with a commercial competitive ELISA showed that the method has greater quantitative accuracy. This newly developed and validated method appears sufficiently sensitive and accurate to quantitate the amount of wheat gluten before fermentation, in select fermented dairy products.

The Relationship between Functional Constipation and Dietary Habits in School-Age Japanese Children

Functional constipation negatively affects school-related quality of life for children and adolescents. We investigated the association between functional constipation, defined according to the Rome criteria version III, and dietary habits. The subjects of this cross-sectional study were 1,140 5th graders and 1,054 8th graders attending schools in Shunan City, Japan in 2012. Functional constipation was defined as having two or more symptoms of constipation. Dietary habits were assessed using a brief questionnaire. Self-reported biological, demographic and lifestyle information was obtained. Using multiple logistic models, dose-dependent associations among subgroups stratified with quintiles of nutrient and food intake were examined. The prevalence of functional constipation ranged from 3.7% to 8.3% across the grades. The most prevalent symptom was pain or hard stools. There was a link between higher rates of functional constipation and lower levels of dietary fiber intake, vegetables, and fruits (p_trend=0.010-0.030). Associations with vegetables and fruits attenuated when controlling for dietary fiber intake (p_trend=0.074-0.150). When 5th and 8th graders were separately analyzed, intake of dietary fiber, water from foods, and vegetables had beneficial effects on functional constipation in 8th graders (p_trend=0.005-0.038), and fruit intake had a beneficial effect in 5th graders (p_trend=0.012). Modification of dietary habits may have a positive effect in reducing functional constipation in school-age children. Diets rich in fiber, vegetables, and fruits, have the potential to improve functional constipation in Japanese children and adolescents.

Deciphering role of FGFR signalling pathway in pancreatic cancer

Recently, fibroblast growth factors are identified to play a vital role in the development and progression of human pancreatic cancer. FGF pathway is critical involved in numerous cellular processes through regulation of its downstream targets, including proliferation, apoptosis, migration, invasion, angiogenesis and metastasis. In this review article, we describe recent advances of FGFR signalling pathway in pancreatic carcinogenesis and progression. Moreover, we highlight the available chemical inhibitors of FGFR pathway for potential treatment of pancreatic cancer. Furthermore, we discuss whether targeting FGFR pathway is a novel therapeutic strategy for pancreatic cancer clinical management.

Differences in the macronutrient and dietary fibre profile of gluten-free products as compared to their gluten-containing counterparts

BACKGROUND/OBJECTIVES

Gluten-free diet is the lifelong therapy for patients with coeliac disease. A wide range of gluten-free products (GFP) is available, which mimics the characteristics of their gluten-containing counterparts (GCC). The aim of this study was to compare the macronutrient and dietary fibre composition of GFP and GCC currently available in Spain.

SUBJECTS/METHODS

A cross-sectional study analysing the nutritional differences between 621 GFP and 600 GCC based on labelling information was conducted. Food items were categorized in one of 14 food groups. The first six ingredients were noted for each food item. A linear regression model was used to explain differences in nutritional composition between GFP and GCC and three independent models were created for bread, pasta and biscuits.

RESULTS

Results showed that GCC had higher protein content than GFP, especially in flour, bread, pasta and pizza. Bread had higher total and saturated fat contents in the GFP in which palm oil was the main fat used. Flours and starchy ingredients used in GFP formulation were mainly rice and corn flours and corn starch, and palm oil was the most commonly used fat.

CONCLUSIONS

In conclusion, GFP cannot currently be considered as equivalent substitutes for their GCC. The reformulation of the GFP with more healthy ingredients and ingredients is encouraged, using a healthy oil, pseudocereals and whole flour.

High expression of RAB38 promotes malignant progression of pancreatic cancer

Ras-Related Protein Rab-38 (RAB38), which belongs to the RAB family, is involved in the biogenesis of lysosome-related organelles and defense against certain microbial infections. However, the clinical significance and potential function of RAB38 in pancreatic adenocarcinoma remain unclear. In the present study, an immunohistochemical assay was performed to analyze the expression of RAB38 in pancreatic adenocarcinoma tumor specimens from 82 patients, and the clinicopathological characteristics and survival rate of these patients were further examined. To validate the role of RAB38 in tumors, the effect of RAB38 on tumor cell proliferation, migration and invasion was assessed by establishing RAB38 knockdown cell lines. Reverse transcription-quantitative polymerase chain reaction and western blotting were used to examine the expression levels of proteins associated with the cancer cell behavior. In addition, the inhibitory effect of RAB38 silencing on pancreatic cancer was examined in mice. The immunohistochemistry results revealed that RAB38 was upregulated and positively correlated with the grade of progression in pancreatic adenocarcinoma patients. Further investigation indicated that RAB38 downregulation significantly suppressed the proliferation, migration and invasive capacity of pancreatic cancer cells, as well as decreased the expression levels of Ki67, proliferating cell nuclear antigen, and matrix metalloproteinases 2 and 9. RAB38 silencing also inhibited the development of pancreatic cancer in vivo. Taken together, a high level of RAB38 was significantly associated with the malignant phenotypes of pancreatic cancer, suggesting that RAB38 may serve as a novel biomarker and a potential therapeutic target for pancreatic cancer.

An automated identification and analysis of ontological terms in gastrointestinal diseases and nutrition-related literature provides useful insights

With an unprecedented growth in the biomedical literature, keeping up to date with the new developments presents an immense challenge. Publications are often studied in isolation of the established literature, with interpretation being subjective and often introducing human bias. With ontology-driven annotation of biomedical data gaining popularity in recent years and online databases offering metatags with rich textual information, it is now possible to automatically text-mine ontological terms and complement the laborious task of manual management, interpretation, and analysis of the accumulated literature with downstream statistical analysis. In this paper, we have formulated an automated workflow through which we have identified ontological information, including nutrition-related terms in PubMed abstracts (from 1991 to 2016) for two main types of Inflammatory Bowel Diseases: Crohn’s Disease and Ulcerative Colitis; and two other gastrointestinal (GI) diseases, namely, Coeliac Disease and Irritable Bowel Syndrome. Our analysis reveals unique clustering patterns as well as spatial and temporal trends inherent to the considered GI diseases in terms of literature that has been accumulated so far. Although automated interpretation cannot replace human judgement, the developed workflow shows promising results and can be a useful tool in systematic literature reviews. The workflow is available at https://github.com/KociOrges/pytag.

How to improve the gluten-free diet: The state of the art from a food science perspective

The celiac disease is the most common food intolerance and its prevalence is increasing. Consequently, use of gluten-free diet has expanded, notwithstanding consumption as therapy for other gluten-related disorders or by wellbeing people without any medical prescription. Even the therapeutic efficiency has undoubtedly proven, several drawbacks mainly regarding the compliance, nutritional deficits and related diseases, and the alteration of the intestinal microbiota have described in the literature. Food science has been considered as one of the primary area of intervention to limit or eliminate such drawbacks. Efforts have approached shelf life, rheology and palatability aspects but more recently have mainly focused to improve the nutritional features of the gluten-free diet, and to propose dietary alternatives. The sourdough fermentation has shown the most promising results, also including a biotechnology strategy that has allowed the complete degradation of gluten prior to consumption.

Characteristics of starch breads enriched with red potatoes

Starch breads may often be low in nutritional value, in comparison to traditional products, as they contain less dietary fibre, protein and micro and macro elements. As an effect a risk of mineral deficiencies and digestive problems caused by lack of dietary fibre could be expected in persons adhering to gluten free diet. To eliminate such problems, a continuous research on gluten-free bread nutritional enrichment, has been done in recent years. Raw material used to enrich gluten free products should include: inulin, lupine, radish, soy, lucerne sprouts, oilseeds, different type of dried fruits. Among the most commonly used raw materials, there are flours from gluten free cereals and pseudocereals such as buckwheat, amaranth and maize are very popular. It seem that valuable alternative could be considered a red, purple or pink potatoes as starch breads additives. The aim of this work was to investigate the effect addition of freeze-dried color potatoes on crude fiber, polyphenols, anthocyanins and flavonoids and nutritional value of gluten free breads. It could be concluded, that freeze-dried color (red, purple, pink) potatoes enriched the gluten free breads (starch breads) with health promoting bioactive components, like polyphenols, and highly valuable protein. The most promising additive was Magenta Love red potato variety lyophilisates, because gluten free breads enriched with this component were characterized by high protein content and the highest content of free and bound polyphenols, flavonoids, anthocyanins. The presence of all these components increased the nutritional and pro-health value of gluten free product as starch bread.

Gastrointestinal disease in Sjogren's syndrome: related to food hypersensitivities

Patients with Sjogren’s syndrome (SS) frequently have irritable bowel like symptoms (IBS). Some have celiac sprue. The current studies were designed to examine the presence of food hypersensitivities in a population of patients with SS and IBS. Ten patients were selected from the autoimmune disease clinics at SUNY at Buffalo who had SS and IBS symptoms. Food hypersensitivities were determined by specific IgG ImmunoCAP^® assays. Symptoms of abdominal pain, bloating, diarrhea and joint pain were eliminated with dietary restriction of foods to which hypersensitivity was demonstrated. Symptoms recurred with re-institution of offending foods. Resolution of fatigue required elimination of offending foods as well as treatment of underlying metabolic disorders. The presence of IBS in patients with SS should lead to investigation of food hypersensitivities as possible culprits.

Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment

Low bone mineral density (BMD), osteopenia, and osteoporosis are frequent complications of celiac disease (CD). The etiology of pathologic bone alterations in CD is multifactorial; however, two main mechanisms are involved: intestinal malabsorption and chronic inflammation. A strict gluten-free diet (GFD) is thought to be the only effective treatment for CD; but treating bone complications related to CD remains complex. The objective of this review is to elucidate the bones problems related to CD and to increase awareness of osteoporosis development, considered as a sign of atypical CD presentation. Currently, a question of whether GFD alone is an effective treatment to correct the bone alterations in patients with CD is under debate. This review presents factors contributing to pathologic bone derangement, recent research on the epidemiology of low BMD, osteoporosis, and fractures, and the treatment of bone problems in patients with CD. The roles of calcium and transport mechanisms are additionally presented.

Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients

Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B₆, B₁₂, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B₆ 14.5%, folic acid 20%, and vitamin B₁₂ 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

Gene Expression Profiling of Gliadin Effects on Intestinal Epithelial Cells Suggests Novel Non-Enzymatic Functions of Pepsin and Trypsin

Gliadin triggers T-cell mediated immunity in celiac disease, and has cytotoxic effects on enterocytes mediated through obscure mechanisms. In addition, gliadin transport mechanisms, potential cell surface receptors and gliadin-activated downstream signaling pathways are not completely understood. In order to screen for novel downstream gliadin target genes we performed a systematic whole genome expression study on intestinal epithelial cells. Undifferentiated Caco-2 cells were exposed to pepsin- and trypsin- digested gliadin (PT-G), a blank pepsin-trypsin control (PT) and to a synthetic peptide corresponding to gliadin p31-43 peptide for six hours. RNA from four different experiments was used for hybridization on Agilent one color human whole genome DNA microarray chips. The microarray data were analyzed using the Bioconductor package LIMMA. Genes with nominal p<0.01 were considered statistically significant. Compared to the untreated cells 1705, 1755 and 211 probes were affected by PT-G, PT and p31-43 respectively. 46 probes were significantly different between PT and PT-G treated cells. Among the p31-43 peptide affected probes, 10 and 21 probes were affected by PT-G and PT respectively. Only PT-G affected genes could be validated by quantitative real-time polymerase chain reaction. All the genes were, nonetheless, also affected to a comparable level by PT treated negative controls. In conclusion, we could not replicate previously reported direct effects of gliadin peptides on enterocytes. The results rather suggest that certain epitopes derived from pepsin and trypsin may also affect epithelial cell gene transcription. Our study suggests novel non-enzymatic effects of pepsin and trypsin on cells and calls for proper controls in pepsin and trypsin digested gliadin experiments. It is conceivable that gliadin effects on enterocytes are secondary mediated through oxidative stress, NFkB activation and IL-15 up-regulation.

Unintentional weight loss in a renal transplant recipient: do not overlook coeliac disease

Unintentional weight loss in a renal transplant recipient is an important condition, requiring diagnostic search within the framework of malignancy and opportunistic infections. To the best of our knowledge, there are no data in the literature reporting underlying coeliac disease as the cause of significant weight loss after renal transplant. We report a 32-year-old woman, who complained of significant weight loss during the 3.5 years posttransplant. Diagnostic work-up revealed coeliac disease, and a gluten-free diet stabilized her weight loss. Considering the high frequency of coeliac disease, this should be kept in the differential diagnosis of renal transplant recipients presented with weight loss and other suggestive features.

Atypical celiac disease: from recognizing to managing

The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician's daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD.

The relationship between quality of life and coping strategies of adults with celiac disease adhering to a gluten-free diet

In the United States, the prevalence of celiac disease has increased from 1 in 4,600 persons to 1 in 133 persons during the past 10 years. Although celiac disease can be managed by strict adherence to a gluten-free diet, dietary management can be challenging. A descriptive, correlational design was used to examine factors and perceived causes that interfere with adherence to a gluten-free diet, identify coping strategies, and examine the relationship between coping strategies and quality of life in 156 adults with a diagnosis of celiac disease. The Psychological General Well-Being Index and the Brief COPE were used to measure the major variables. Results indicated that problems outside the home interfere with dietary adherence. A moderate negative significant relationship (r [154] = -.46, p < .01) was found between quality of life and stress, with 54% of participants reporting a minimal amount of stress. Emotion-focused coping was found to have a significant negative effect on quality of life (H[18] = 56.67, p < .001). Implications for future research should include investigation of cognitive behavioral interventions to decrease the negative effects of stress on quality of life for adults with celiac disease adhering to a gluten-free diet.

Biochemical and immunochemical characterization of different varieties of amaranth (Amaranthus L. ssp.) as a safe ingredient for gluten-free products

Celiac disease is a food intolerance triggered by the ingestion of gluten-containing cereals; the only therapy is a strict gluten-free diet for life. In recent years, amaranth flour has received considerable attention as an interesting source for the formulation of gluten-free products due to its high nutritional value and low content of prolamins, the toxic proteins for celiacs. The aim of this study was to characterize 40 amaranth varieties using both SDS-PAGE/immunoblotting and ELISA to assess their possible tolerance by celiac subjects. All of the amaranth samples studied showed similar binding affinities for both specific anti-gliadin antibodies and human IgAs. In most amaranth grains, the content of gluten-like proteins measured by ELISA was <20 ppm. The molecular characterization of amaranth proteins suggests that amaranth is safe for celiacs to consume. It is recommended that the most suitable amaranth varieties are those having the lowest content of proteins cross-reacting with anti-gliadin antibodies.

Nutrigenetics and nutrigenomics: viewpoints on the current status and applications in nutrition research and practice

Nutrigenetics and nutrigenomics hold much promise for providing better nutritional advice to the public generally, genetic subgroups and individuals. Because nutrigenetics and nutrigenomics require a deep understanding of nutrition, genetics and biochemistry and ever new 'omic' technologies, it is often difficult, even for educated professionals, to appreciate their relevance to the practice of preventive approaches for optimising health, delaying onset of disease and diminishing its severity. This review discusses (i) the basic concepts, technical terms and technology involved in nutrigenetics and nutrigenomics; (ii) how this emerging knowledge can be applied to optimise health, prevent and treat diseases; (iii) how to read, understand and interpret nutrigenetic and nutrigenomic research results, and (iv) how this knowledge may potentially transform nutrition and dietetic practice, and the implications of such a transformation. This is in effect an up-to-date overview of the various aspects of nutrigenetics and nutrigenomics relevant to health practitioners who are seeking a better understanding of this new frontier in nutrition research and its potential application to dietetic practice.

Celiac disease, gluten-free diet, and oats

Oats in a gluten-free diet increase the diet's nutritional value, but their use remains controversial. Contamination with prolamins of other cereals is frequent, and some clinical and experimental studies support the view that a subgroup of celiac patients may be intolerant to pure oats. Thus, this issue is more complex than previously suggested. In order to produce oats that are safe for all celiac patients, the following topics should be addressed: selection of oat cultivars with low avenin content, research on such recombinant varieties of oats, development of assay methods to detect avenins in oat products, guidelines for the agricultural processing of oats and the manufacture of oat products, as well as guidelines for following up with celiac patients who consume oats.

Nutritive value and chemical composition of pseudocereals as gluten-free ingredients

The only treatment available for patients with coeliac disease is a lifelong elimination of food products containing gluten. The gluten-free products currently available in the market are considered of low quality and poor nutritional value. In the present study, the pseudocereals amaranth, quinoa and buckwheat were studied as potential healthy ingredients for improving the nutritional quality of gluten-free breads. The pseudocereal seeds and pseudocereal-containing gluten-free breads were evaluated in terms of their protein, fat, total starch, dietary fibre, ash and mineral content as well as their fatty acid composition. The pseudocereal containing gluten-free breads showed significantly higher levels of protein, fat, fibre and minerals than the control bread. The attributes of these breads conform to the expert's nutritional recommendations for the gluten-free diet and gluten-free foods. These results suggest that the pseudocereals amaranth, quinoa and buckwheat can represent a healthy alternative to frequently used ingredients in gluten-free products.

Recent advances in refractory coeliac disease: a review

Coeliac disease (CD) is an immune-mediated disease of the small intestine caused by intolerance to gluten. Removal of gluten from the diet results in a return to normal health for the majority of patients. A significant proportion of patients do not respond to a gluten-free diet and are considered to be suffering from refractory coeliac disease (RCD). Two types of RCD are now recognized: type 1 RCD is characterized by a polyclonal population of intraepithelial lymphocytes (IELs) with a normal immunophenotype, and type 2 RCD shows monoclonal IELs with an aberrant immunoprofile. Patients with RCD have a high risk of complications such as ulcerative jejunitis (UJ) and enteropathy-type T-cell lymphoma (ETTL). RCD2 may represent an early stage in the development of overt lymphoma. The diagnosis of RCD, therefore, has important implications, but remains a challenging area. In this paper we review the latest developments in RCD, including the diagnostic approach and a discussion of the key clinical, histological, immunohistochemical and molecular features of RCD and its complications.

Coeliac disease presenting with bilateral fibular stress fractures

We present the case of an apparently healthy 22-year-old female who presented with atraumatic stress fractures of both fibulae. Further investigation demonstrated that she had osteopoenia secondary to occult coeliac disease. The fractures were successfully treated non-operatively. The awareness of the prevalence of occult coeliac disease is increasing due to simpler diagnostic tests, as is its significance as a cause of secondary osteoporosis. Knowing the relationship between these two conditions will help orthopaedic surgeons treating such patients to refer them promptly to appropriate specialists.

Intragenomic rearrangement in TT viruses: a possible role in the pathogenesis of disease

A role for the ubiquitous Torque teno (TT) viruses in the pathogenesis of disease has not been resolved. In vivo and in vitro intragenomic rearrangement of TT virus genomes has been demonstrated. Replication in cell culture of a subviral molecule (411 bp) occurs through oligomerisation of RNA transcripts. Although the functions of the respective TT viral genes, as well as the newly formed genes in the rearranged subviral molecules, are largely unknown, certain similarities to genes of plant viruses of the family Geminiviridae will be described. A degree of similarity to certain cellular genes poses the question as to a role of molecular mimicry in the pathogenesis of autoimmune disease and diabetes.

Bone in celiac disease

Chronic inflammation and malabsorption in celiac disease (CD) can cause bone metabolism alterations and bone mineral loss in children and adults. Bone status before and after gluten-free diet, epidemiology of fractures, and possible treatment options for CD-related osteoporosis are presented. Controversial aspects of this complication of CD are discussed. The relationship between bone derangements and celiac disease (CD) was recognized almost 50 years ago, but many questions are still open. We are now aware that osteoporosis is a relatively frequent atypical presentation of CD, especially in adults, and that undiagnosed CD can be the cause of osteoporosis and related fractures. Chronic inflammatory intestinal diseases, including CD, can affect bone and mineral metabolism because of alterations in both systemic and local regulatory factors. The pathogenetic processes are still controversial, but two main mechanisms seem to be involved: intestinal malabsorption and the presence of chronic inflammation. This review analyzes the published data on bone involvement in children, adolescents, and adults either before or after a gluten-free diet. Special attention is paid to the epidemiology of fractures in celiac patients, considering that fractures are a major complication of osteoporosis and an important problem in the management of a chronic disease like CD. The usefulness of screening osteoporotic patients systematically for CD is still an open question, but some rules can be given. Finally, the current treatment options for children and adults are discussed. Recommendations for future clinical research are proposed.