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How Are Gluten Immunogenic Peptides Like Santa Claus?

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.

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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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So just to clarify had not consumed any gluten for about 4 days before testing. I was assured by my allergist that it wouldn't affect the test. But what was alarming was that she retested my food allergies (my most recent reaction was two weeks ago) and every food allergy I have came back negative. I don't understand how that is possible. These food allergies developed when I was 20 and I am almost 24 now.

Thanks! You too! I have learned from this experience to take charge of my own health. It's nice at least that we can try the gluten-free treatment without a firm diagnosis or a doctor confirming the disease. I've also felt some of the gluten withdrawal symptoms, and my stomach pain ebbs and flows, but I'm determined to stick with the gluten-free diet to see what a difference it makes. Gemini, thank you! This was really validating and useful for me to hear. I've felt so confused through this process and just want some answers. If the biopsy results do come back negative, I'm going to follow your advice and do the gluten-free diet with repeat blood testing after a while. If they come back positive, well, then I'll have my answer. I'm supposed to get them back next week.

I have celiac and eosinaphalic esophagitis. I was put on a steroid inhaler recently. I use it like an inhaler but swallow the air instead of breathing it in. You may want to look into EOE and it's relationship to celiac. Just a thought. My swallowing and celiac seem to be related.

You have eat gluten every single day until after testing. And the celiac blood test is supposed to be done as well.

If I was the big guy, there's no way I would have to wait 3 and a half weeks for a test lol. My GI doc never recommended the antibody test. He said doing it with the scope was the only sure way to know. Does anybody know if I should eat a little gluten the day before my test to see if I will get an accurate enough test? Or will it not matter, once the damage is done it's done?