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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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It took me 20 years or more Barry so I wouldn't claim any great insight on this I had a 'eureka' moment, up until then I was walking around with multiple symptoms and not connecting any dots whatsoever. It is very, very difficult to diagnose and that's something that's reflected in so many of the experiences detailed here. A food diary may help in your case. It helped me to connect the gaps between eating and onset. It could help you to track any gluten sources should you go gluten free. It is possible for your reactions to change over time. As to whether its celiac, that's something you could explore with your doctor, stay on gluten if you choose to go that way. best of luck! Matt

I took Zoloft once. Loved it until it triggered microscopic colitis (colonoscopy diagnosed it). Lexapro did the same. However, I have a family member who is fiagnosed celiac and tolerates Celexa well.

Thanks for the update and welcome to the club you never wanted to join! ?

Jmg, I am glad you were able to come to the realisation that the culprit was in fact gluten. For me its not so simple. IBS runs in the family, as do several food intolerances. Its just in the last while that I can finally reach the conclusion that for me its gluten. The fact that it is a delayed effect-several hours after, made it harder. Friday I had some KFC, felt great. Saturday evening felt sleepy, Sunday felt awful and my belly was huge. I think I have gone from mildly sensitive to full blown celiac over the course of five years-if that possible. Thanks for all your help.

I thought I'd take a moment to provide an update, given how much lurking I've done on these forums the last year. It took a long time, but I've since had another gastroenterologist visit, many months of eating tons of bread, and an endoscopy where they took several biopsies. I have to say, the endoscopy was a super quick and efficient experience. During the procedure they let me know that it looked somewhat suspicious, causing them to take many biopsies, and then did comprehensive blood work. About a month later, I received a call telling me that the TTG came back positive a second time, and that the biopsies were a mix of negative (normal) results and some that were positive (showing blunting of the villi). As a result, I've been given a celiac diagnosis. It's been about a month now that I've been eating gluten free. Not sure if I'm really feeling all that different yet. It's a bit twisted to say, but in some way I was hoping for this diagnosis ? thinking how nice it would be to have an explanation, a plan of action, and feeling better. It's certainly no small change to be totally gluten free, but I'm hopeful.