Celiac.com 12/21/2015 - For people with celiac disease, gluten immunogenic peptides might reveal whether you've been bad or good on your gluten-free diet, and whether or not you have gut damage.

Photo: CC-- Sam HowzitIn fact, the best way to spot transgressions in the gluten-free diet and incomplete mucosal healing in people with celiac disease might just be to check for gluten immunogenic peptides in their urine.

For people with celiac disease, the presence of gluten immunogenic peptides in the urine indicates a break in the gluten-free diet, along with incomplete mucosal healing.

How do we know this? Because available methods to determine gluten-free diet adherence couldn't detect occasional gluten ingestion that may cause gut mucosal damage, a team of researchers recently set out to develop a method to assess gluten intake, monitor gluten-free diet compliance in celiac patients, and to correlate those results with mucosal damage.

The research team included María de Lourdes Moreno, Ángel Cebolla, Alba Muñoz-Suano, Carolina Carrillo-Carrion, Isabel Comino, Ángeles Pizarro, Francisco León, Alfonso Rodríguez-Herrera, and Carolina Sousa. They are variously affiliated with the Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain, with Biomedal S.L., Sevilla, Spain, with Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío in Sevilla, Spain, with Celimmune, Bethesda, Maryland, USA, and with Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.

For their study, the research team collected urine samples of 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides (GIP) in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIP, along with an LFT reader.

They found that, in healthy individuals previously subjected to a gluten-free diet, GIP were detectable in concentrated urines as early as 4–6 hours after single gluten intake, and remained detectable for 1–2 days. The urine assay revealed deviation from a gluten-free diet in about 50% of the patients.

Analysis of duodenal biopsies showed that nearly 90% of celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with measurable GIP in urine showed incomplete intestinal mucosa recovery.

GIP are easily detected in urine after gluten consumption, enabling a new and non-invasive method to monitor gluten-free diet compliance and deviation. The method was sensitive, specific and simple enough to be convenient for clinical monitoring of celiac patients, as well as for basic and clinical research applications, including drug development.

Such tests could be very useful for both doctors and patients looking to monitor gluten-free dietary progress and gut healing in people with celiac disease, to say nothing of research and treatment development.


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