Research Summary: Intestinal cell damage and systemic activation in individuals reporting sensitivity to wheat in the absence of celiac disease Uhde M, Ajamian M, Caio G et al (2016) Gut. e-pub ahead of print. doi:10.1136/gutjnl-2016-311964
Uhde M, Ajamian M, Caio G et al (2016)
Gut. e-pub ahead of print. doi:10.1136/gutjnl-2016-311964
Non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) have been often used to describe individuals suffering from a wide range of gastrointestinal symptoms commonly associated with celiac disease (CD).
Gut. e-pub ahead of print. doi:10.1136/gutjnl-2016-311964
Non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) have been often used to describe individuals suffering from a wide range of gastrointestinal symptoms commonly associated with celiac disease (CD).
This study attempts to find a link between the immune response to gliadin (a protein component of gluten) and damage to the intestinal wall in these individuals. Moreover, researchers try to understand a correlation between the translocation of intestinal microorganisms within the damaged intestinal lining and the immune response.
The study included 80 subjects with NCGS and NCWS whose symptoms were evaluated prior to and during a gluten-restricted diet. Blood serum samples collected from all participants prior to the dietary restriction were also available for evaluation, including 20 samples collected prior and post a 6-month gluten-free diet. Finally, 40 samples from celiacs and a healthy control group each were also available during the study.
The NCWS group had a significantly higher elevation in antibodies against gliadin than the control group. 26% within that group expressed the CD-specific HLA class II genes, however this is common to the general population. 60% had no mucosal damage and the remaining 40% presented with no significant damage to the intestinal wall. Conversely, all the celiacs expressed the HLA class II genes (which is expected) and presented with significant mucosal damage. Lipopolysaccharide binding protein (LBP) that binds to bacterial compounds stimulating the immune response was significantly elevated in the NCWS group in comparison with the control group or even the celiacs. IgM endotoxin-core antibodies that neutralize circulating bacterial endotoxin were also significantly higher in this group; as were antibodies to flagellin (a protein found in bacterial flagella). All these markers also correlated with significantly elevated levels of fatty acid-binding protein 2 (FAB2) used to identify acute intestinal injury. These findings point towards bacterial translocation in the small intestine that stimulates the immune response in the NCWS subjects if gluten-containing foods are not eliminated from the diet.
When on the gluten-restricted diet, all the study subjects showed symptomatic improvement as well as a reduction in the levels of all the immune markers discussed in this study. Although the study succeeded in providing evidence of the availability of specific markers in the diagnosis of NCWS, further research may be required to better understand how these markers could potentially be utilized in the NCWS diagnosis as well as monitoring and evaluation of the treatment process.
The study included 80 subjects with NCGS and NCWS whose symptoms were evaluated prior to and during a gluten-restricted diet. Blood serum samples collected from all participants prior to the dietary restriction were also available for evaluation, including 20 samples collected prior and post a 6-month gluten-free diet. Finally, 40 samples from celiacs and a healthy control group each were also available during the study.
The NCWS group had a significantly higher elevation in antibodies against gliadin than the control group. 26% within that group expressed the CD-specific HLA class II genes, however this is common to the general population. 60% had no mucosal damage and the remaining 40% presented with no significant damage to the intestinal wall. Conversely, all the celiacs expressed the HLA class II genes (which is expected) and presented with significant mucosal damage. Lipopolysaccharide binding protein (LBP) that binds to bacterial compounds stimulating the immune response was significantly elevated in the NCWS group in comparison with the control group or even the celiacs. IgM endotoxin-core antibodies that neutralize circulating bacterial endotoxin were also significantly higher in this group; as were antibodies to flagellin (a protein found in bacterial flagella). All these markers also correlated with significantly elevated levels of fatty acid-binding protein 2 (FAB2) used to identify acute intestinal injury. These findings point towards bacterial translocation in the small intestine that stimulates the immune response in the NCWS subjects if gluten-containing foods are not eliminated from the diet.
When on the gluten-restricted diet, all the study subjects showed symptomatic improvement as well as a reduction in the levels of all the immune markers discussed in this study. Although the study succeeded in providing evidence of the availability of specific markers in the diagnosis of NCWS, further research may be required to better understand how these markers could potentially be utilized in the NCWS diagnosis as well as monitoring and evaluation of the treatment process.
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