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Can Celiac Disease Disappear After Allogeneic Bone Marrow Transplant?

Celiac.com 01/06/2014 - A team of researchers recently set out to clarify the role of the immune system and intestinal epithelium in the origins of celiac disease.

Bone Marrow Diagram: CC--Wikimedia CommonsThe research team included S. Ben-Horin, S. Polak-Charcon,I. Barshack, O. Picard, E. Fudim, M. Yavzori, C. Avivi, C. Mardoukh, A. Shimoni, Y Chowers, Y. and Maor, of the Department of Gastroenterology in Chaim Sheba Medical Center at Tel-Aviv University, Tel Hashomer in Tel-Aviv, Israel.

For five years, the team followed a patient with childhood celiac disease who had undergone an allogeneic bone marrow transplant (BMT) for chronic myelogenous leukemia, and subsequently resumed consuming a gluten-containing diet.

Using standard serology testing, along with CFSE-based proliferation assays of peripheral blood CD4+ cells and of intestinal LPL towards gliadin-TTG antigens, the team assessed immunological memory to gliadin epitopes in both the control patient and in 5 newly diagnosed celiac patients.

They used combined immuno-histochemistry and fluorescent in-situ hybridiazation (FISH) to determine the origin of the intestinal lymphocytes.

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They found that the patient remained healthy for more than 5 years of follow-up after receiving BMT from a HLA-matched woman, and ceasing the gluten-free diet. The continued to show negative periodic antibodies tests and unremarkable serial duodenal biopsies.

In vitro tests showed lack of a memory response of the patient's peripheral blood and lamina propria CD4+ T-cells towards TTG, gliadin or TTG-treated gliadin, whereas memory responses were common in the newly diagnosed celiac patients.

Immuno-FISH of post-BMT duodenal mucosa showed that all the epithelial cells had the chromosomal phenotype of XY. In contrast, CD45+ lymphocytic lineage cells were all donor-derived XX cells, presumably originating in the transplanted bone marrow and re-populating the intestinal wall.

The resolution of celiac disease after allogeneic BMT does occur, and is associated with absent gliadin-specific memory response, and with a dichotomous lymphocyte-epithelial chimeric intestine. These findings suggest that the origins of celiac disease are deeply connected to the immune system, rather than the epithelial area.

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5 Responses:

 
Sue
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said this on
09 Jan 2014 2:41:32 PM PDT
Fascinating! Does make me question if I should be on the bone marrow transplant list of donors. I'd hate for someone to recover and then learn they have celiac disease instead of luekemia.

 
Roberta
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said this on
13 Jan 2014 6:11:31 PM PDT
What does one have to do to get on a bone marrow transplant list?

 
sc'Que?
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said this on
14 Jan 2014 2:07:55 AM PDT
This study seems like it will have long-reaching effects in how celiac disease is researched in the future. Please follow up on this kind of study!

 
Hilary
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said this on
14 Jan 2014 3:48:43 AM PDT
Jefferson! as usual you find the most interesting finds. This article and the study are something that gives hope to all of us with celiac disease. The science and reporting were excellent from the looks. Thanks again so much.

 
Pussycat21
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said this on
14 Jan 2014 4:22:44 PM PDT
This article is very interesting as the coeliac disease is cured. For any researchers reading this post I have three coeliacs in my immediate family. My daughters also has Hashimotos and POCS. When my children were young they contracted Kawasaki Disease and were given gamma goblin blood products ( a mix of different peoples' immune systems). For the five years after the transfusion their autoimmune diseases improved immensely. Some research into this would be interesting as it may not take bone marrow to get a cure.




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I have been having issues with gluten for quite some time now and decided to go gluten free back in October, I finally got the celiac blood test a couple weeks ago and it came back inconclusive. My doctor referred me to a gastroenterologist who I saw today, she told me I'd have to eat gluten rich foods for 1 month and then have another blood test done....of it comes back negative she said I'd need to eat gluten another few weeks (up to another month) and then do a scope and biopsy....this would be hell on me as I have severe cramping and nausea when I am exposed to gluten. I haven't actually eaten anything that is straight gluten like bread so I'm not sure what would happen. She gave me the option to hold off and continue my diet or go through 2 months of pure gluten exposure (and pain) my question is has anyone been faced with this? Should I just continue with my gluten free diet and assume I have it or is the diagnosis really that important? Doc says based on my symptoms and reactions I more than likely have it.

Hello everyone, My name is Alessio, I'm a 25 year old male and for 24 of my 25 years I've been healthy as a rock. Things changed in July 2016 when I decided to quit smoking using Chantix. 3 weeks in the treatment to quit smoking I started suffering from insane anxiety (an entire week of depersonalization) and daily panic attacks, I was hospitalized for a week and sent home with Clonazepam (Klonopin) for the following couple of months which at the time helped a lot. At the time I was quite convinced that what I went through must have been a side effect of chantix but almost a year later and with the Celiac diagnosis I sort of suspect that quitting smoking might have triggered Celiac Disease for me, hence the panic attacks and the anxiety. Around November 2016 I started suffering from throat flares, which was found to be acid reflux ( I very rarely suffered from heartburn, maybe a couple of occasions) but the throat flare was constant, from the moment I ingested something in the morning till when I went to bed. Turned out to be caused by Celiac as well (as soon as i started my gluten-free diet in late December the flare just vanished over a week time). I had my biopsy 5 days ago, on the 20th of April and in the GI notes he wrote that there were no signs of cancer, acid damage or ulcers but he could see villous atrophy. Leading up to the biopsy I had to go back to eating gluten for a month a half and that's where the current problems started. I have had a sore throat for the last 4 and a half weeks and 2 lymph nodes very close to the adam's apple (just above it, slightly to the side on both sides) have gotten hard. I've had an ultrasound on the one on my left ( which was the very first one to appear) and it showed a 2cm growth that showed no sign of malignancy, this node at the time was tender and moveable ( a good sign I've been told). On the right side of my neck the node seems to be hard and not moveable. I've had a CT scan for my neck ( I haven't personally seen the results yet) but my doctor does not seem concerned. I have been tested for Strep and Mono and both turned out to be negative. 2 weeks ago I started suffering from a very acute burning sensation just between my breasts and shoulders on both sides, it lasted for 3 days straight and woke me up several times and the fourth day i woke up with soreness ( which still persists) in the same areas that were burning, this lead my doctor to test me for Rheumatoid Factor and presence of ANA, the RF turned out to be 10 ( <12 is not indicative of disease) and my ANA were positive to a titer of 1:80 with a speckled pattern, again my doctor shows no signs of concern regarding this. I am suffering from chronic fatigue at the moment and being a carpenter that really doesn't make life easy. I have lost around 20 pounds in the last 2 months, went from my standard 180 pounds to 160 and to today I don't know if I can attribute that to my gluten-free diet ( and minor cutoff of junk food) or whether there might be a second underlying issue going on right now. All in all since doing my gluten challenge I haven't been feeling well. My question is, can what's been going on in the last month ( hard nodes, sore throat, fatigue, weight loss and inflammation outside my gut) be just another reaction to gluten? I'm 5 days into the gluten-free diet again and no improvements yet, I know that it usually takes a couple of weeks to have effect. Thanks for your time, and I have learned tons from this website about dealing with Celiac Disease, Thank you. Alessio

@cyclinglady thanks for checking in Restricted diet didn't do much. Still had some VA last time they checked. Heath still otherwise fine, so RCD remains unlikely. My sxs kick in lockstep with life stress, so that kind of points to some general IBS stuff on top of celiac disease. Very doubtful I'm getting any gluten in, but fingers crossed my system is just a little hyper-vigilant, as I ponder on this thread.

I have always noticed that the table wine in Europe is pretty damn good! I am a wine lover and so is my husband but he does like his Green's beer.

The reason they set the limit at 20ppms is that through scientific study, they have proven that the vast majority of people with Celiac Disease do not have an autoimmune reaction to amounts below that......it is a safe limit for most. Also, just because that limit is set at 20ppms, does not mean that gluten-free products contain that amount of gluten. Testing for lower levels becomes more expensive with each increment down closer to 0-5ppms, which translates into higher priced products. Unless you eat a lot of processed gluten-free food, which can have a cumulative affect for some, most people do well with the 20ppm limit.