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Celiac.com 06/12/2023 - Celiac disease is an autoimmune disorder characterized by gastrointestinal symptoms and nutrient deficiencies. While genetic factors, particularly HLA association, play a significant role in its development, the exact environmental triggers remain unclear. Recent studies have proposed infections as potential contributing factors. With the Covid-19 pandemic causing a systemic inflammatory response and affecting the gastrointestinal tract, researchers in southern Sweden set out to investigate whether Covid-19 infection could increase the risk of developing celiac disease. The research team included Jesper Lexner, Ylva Lindroth and Klas Sjöberg. They are variously affiliated with the Department of Gastroenterology and Nutrition, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden; and the Division of Medical Microbiology, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden. The Covid-19 and Celiac Disease Connection To explore the potential association between Covid-19 infection and celiac disease, the researchers identified all patients, including children and adults, in the county of Skåne with newly diagnosed biopsy- or serology-verified celiac disease or positive tissue transglutaminase antibody tests (tTG-ab) from 2016 to 2021. They also identified individuals who tested positive for Covid-19 using PCR or antigen tests in 2020 and 2021. The Findings During the period from March 2020 to December 2021, there were 201,050 cases of Covid-19 in Skåne, and among them, 568 patients were diagnosed with celiac disease or had positive tTG-ab tests. Interestingly, only 35 of these patients had previously been infected with Covid-19. Contrary to initial expectations, the incidence of verified celiac disease and tTG-ab positivity was lower during the Covid-19 pandemic compared to before. The incidence rates of celiac disease were 21.1 and 22.4 cases per 100,000 person-years for patients with and without prior Covid-19 infection, respectively. Implications of the Study The findings of this study suggest that Covid-19 infection is not a significant risk factor for the development of celiac disease. While previous research has indicated that gastrointestinal infections may play a role in the pathogenesis of celiac disease, respiratory infections, such as those caused by the SARS-CoV-2 virus, appear to have less relevance in this regard. Study Limitations It is important to note that this study focused on a specific region in southern Sweden and the findings may not be generalizable to other populations or geographic areas. Further research involving larger and more diverse populations is warranted to validate these findings. Additionally, the study did not explore potential mechanisms underlying the connection between gastrointestinal infections and celiac disease pathogenesis, highlighting the need for future investigations in this area. Understanding the environmental triggers and risk factors associated with celiac disease is crucial for improving diagnosis, treatment, and prevention strategies. While the Covid-19 pandemic has posed significant challenges worldwide, this study suggests that Covid-19 infection does not increase the risk of developing celiac disease. Read more in BMC Gastroenterology volume 23, Article number: 174 (2023)

Celiac.com 02/21/2023 - We get numerous questions about the gluten-free status of drugs and medications, including in our forum. Lately we've been seeing a bunch of questions about Paxlovid. Mainly, is Paxlovid gluten-free and safe for people with celiac disease? Produced in the U.S. by Pfizer, Paxlovid is the name brand for nirmatrelvir tablets co-packaged with ritonavir tablets. Paxlovid is a drug that has been granted Emergency Use Authorisation (EUA) by the FDA for the treatment of mild-to-moderate COVID-19 in adults and children, who have had a positive SARS-CoV-2 viral test, and face a high risk for progression to severe COVID-19, including hospitalization or death. Is Paxlovid gluten-free and safe for people with celiac disease? The short answer is that Paxlovid is not labeled as gluten-free, and Pfizer cannot guarantee that it is gluten-free. However, Paxlovid contains no gluten ingredients, and is naturally gluten-free. The fact that it must be manufactured in an FDA approved lab should greatly reduce any risk of cross-contamination during the manufacturing process. In addition to the active ingredients, Nirmatrelvir UNII:7R9A5P7H32), and Ritonavir (UNII: O3J8G9O825)... Paxlovid's Inactive Ingredients Include: Microcrystalline Cellulose (UNII: Op1r32d61u) Lactose Monohydrate (UNII: Ewq57q8i5x) Croscarmellose Sodium (UNII: M28ol1hh48) Silicon Dioxide (UNII: Etj7z6xbu4) Sodium Stearyl Fumarate (UNII: 7cv7wjk4ui) Hypromellose 2910 (10000 Mpa.S) (UNII: 0ho1h52958) Titanium Dioxide (UNII: 15fix9v2jp) Polyethylene Glycol, Unspecified (UNII: 3wjq0sdw1a) Ferric Oxide Red (UNII: 1k09f3g675) Copovidone K25-31 (UNII: D9c330md8b) Anhydrous Dibasic Calcium Phosphate (UNII: L11k75p92j) Sorbitan Monolaurate (UNII: 6w9ps8b71j) Silicon Dioxide (UNII: Etj7z6xbu4) Sodium Stearyl Fumarate (UNII: 7cv7wjk4ui) Hypromellose, Unspecified (UNII: 3nxw29v3wo) Titanium Dioxide (UNII: 15fix9v2jp) Polyethylene Glycol 400 (UNII: B697894sgq) Hydroxypropyl Cellulose (1600000 Wamw) (UNII: Rfw2et671p) Talc (UNII: 7sev7j4r1u) Polyethylene Glycol 3350 (UNII: G2m7p15e5p) Polysorbate 80 (UNII: 6ozp39zg8h) If you have celiac disease or gluten intolerance, be sure to check with your doctor or pharmacist before taking Paxlovid, but it is unlikely to contain any gluten ingredients. Side Effects of Paxlovid Stop taking Paxlovid and call a health care provider right away if they experience any of the following signs of an allergic reaction: Hives Trouble swallowing or breathing Swelling of the mouth, lips, or face Throat tightness Hoarseness Skin rash Other possible side effects include: Altered or impaired sense of taste Diarrhea Elevated blood pressure Muscle aches Abdominal pain Nausea Feeling generally unwell For more information, try Dailymed.nlm.nih.gov Read more at YaleMedicine.org Join our forum discussion.

Celiac.com 03/20/2023 - People with celiac disease who contract COVID-19 are twice as likely to be hospitalized as non-celiacs, according to a new U.S. study, published online in Clinical Gastroenterology and Hepatology. However, the study also found that COVID-19 vaccination decreased the risk of hospitalization by nearly 50% for both groups. This is the first study to show the effect of vaccination on reducing the risk of hospitalization in patients with celiac disease and COVID-19 infection. Despite the increased risk of hospitalization, patients with celiac disease did not experience significant differences in intensive care unit requirement, mortality, or thrombosis compared to non-celiacs. The study suggests that celiac disease patients with COVID-19 are not inherently at greater risk for severe outcomes. The researchers compared COVID-19 incidence and outcomes between patients with and without celiac disease before and after vaccination and found similar outcomes between the two groups before vaccination. The study analyzed 171,763 patients diagnosed and treated for COVID-19 at the institution between March 1, 2020, and January 1, 2022, with 110 of those adults having biopsy-proven celiac disease. The median time from biopsy diagnosis of celiac disease to COVID-19 was 217 months, with more than 2 out of 3 patients following a gluten-free diet. Read more at Medscape Medical News

Celiac.com 06/28/2021 - There is a growing body of data to suggest the intestinal action of SARS-CoV-2, with ciliated cells and intestinal enterocytes serving as target cells, due to high expression of ACE2 and TMPRSS2, could possibly trigger celiac disease in predisposed individuals. Indeed, COVID-19 promotes a “cytokine storm” in the intestinal mucosa, triggering epithelial damage that increases barrier permeability, permitting gliadin to "leak" into the intestinal lamina. However, the possible impact of the SARS-CoV-2 infection, and the resulting disease, on celiac disease rates remains unknown, with no data currently available on the development of systemic disorder, or on long-term outcomes. A team of researchers recently set out to highlight the potential risk of a rise in celiac disease rates among genetically predisposed subjects following SARS-CoV-2 infection, based on several factors which could promote the development of celiac disease. The research team included Chiara Maria Trovato, Monica Montuori, Nicoletta Pietropaoli, and Salvatore Oliva. They are variously affiliated with the Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy; and the Hepatology Gastroenterology and Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy. The team used current medical literature to help them hypothesize the role of COVID-19 as a possible trigger for celiac disease development in predisposed individuals. They suggest that genetically predisposed people could be more likely to develop celiac disease following SARS-CoV-2 infection, making COVID-19 a potential driver of increased celiac disease cases in the future. An unexpected rise in celiac cases among genetically predisposed individuals in the wake of the COVID-19 pandemic would support the team's hypothesis. Time will tell if they are right. Stay tuned for more stories regarding COVID-19, celiac disease, and related topics. Read more in the International Journal of Clinical Practice

Celiac.com 05/12/2022 - Recent studies suggest that KIR+CD8+ T cells could offer a path to controlling autoimmune diseases, such as “long COVID,” which emerge after viral infections. Ly49+CD8+ T cells are a subset of CD8+ T cells that have shown immunoregulatory activity in mice. These cells can suppress myelin oligodendrocyte glycoprotein (MOG)–specific pathogenic CD4+ T cells through their cytolytic activity and thereby ameliorate experimental autoimmune encephalomyelitis (EAE). However, whether a similar CD8+ regulatory T cell subset exists in humans and whether its suppressive activity extends beyond autoimmune diseases to play a more general role in peripheral tolerance remains to be determined. A team of researchers recently shared some relevant findings regarding CD8+ T cells in humans. The research team included Jing Li; Maxim Zaslavsky; Yapeng Su; Jing Guo; Michael J Sikora; Vincent van Unen; Asbjørn Christophersen; Shin-Heng Chiou; Liang Chen; Jiefu Li; Xuhuai Ji; Julie Wilhelmy; Alana M McSween; Brad A Palanski; Venkata Vamsee Aditya Mallajosyula; Nathan A Bracey; Gopal Krishna R Dhondalay; Kartik Bhamidipati; Joy Pai; Lucas B Kipp; Jeffrey E Dunn; Stephen L Hauser; Jorge R Oksenberg; Ansuman T Satpathy; William H Robinson; Cornelia L Dekker; Lars M Steinmetz; Chaitan Khosla; Paul J Utz; Ludvig M Sollid; Yueh-Hsiu Chien; James R Heath; Nielsen Q Fernandez-Becker; Kari C Nadeau; Naresha Saligrama; and Mark M Davis. A recent report by Li et al., notes the existence of a similar CD8+ T cell subset in humans, which possess killer cell immunoglobulin-like receptors (KIRs). This function in humans mirrors that in the mouse Ly49 family. These cells are able to suppress self-reactive CD4+ T cells, and are more plentiful in patients with autoimmune conditions, such as celiac disease, multiple sclerosis, and lupus, as well as in patients infected with influenza virus or severe acute respiratory syndrome coronavirus 2. When researchers injected viruses into mice selectively deficient in Ly49+CD8+ T cells, the mice showed normal antiviral immune responses, but they later developed symptoms of autoimmune disease. The team found that CD8+ T cells express inhibitory killer cell immunoglobulin-like receptors (KIRs), making them the human equivalent of Ly49+CD8+ regulatory T cells in mice. These CD8+ T cells are abundant in the blood and inflamed tissues of patients with several different autoimmune diseases. Moreover, these CD8+ T cells easily eliminated pathogenic gliadin-specific CD4+ T cells from the leukocytes of celiac disease patients in vitro. Because of this, KIR+CD8+ T cells could offer a path to controlling autoimmune diseases, such as “long COVID,” which emerge after viral infections. Tellingly, in COVID-19 patients, the team also found elevated levels of KIR+CD8+ T cells, but not CD4+ regulatory T cells, which corresponded to disease severity, and levels of vasculitis. Selective destruction of Ly49+CD8+ T cells in virus-infected mice reversed their infections, and restored their autoimmunity. These results suggest that in humans, as in mice, these regulatory CD8+ T cells act uniquely to suppress pathogenic T cells in autoimmune and infectious diseases. Read more in Science. 2022 Apr 15;376(6590):eabi9591. Also: PubMed. The researchers are variously affiliated with the Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA; the Program in Computer Science, Stanford University, Stanford, CA, USA; the Institute for Systems Biology, Seattle, WA, USA; the Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA; the Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA; the KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway; the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; the Department of Immunology, University of Oslo, Oslo, Norway; The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA; the Human Immune Monitoring Center, Stanford University School of Medicine, Stanford, CA, USA; the Department of Chemistry, Stanford University, Stanford, CA, USA; Sean N; Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA; the Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA; Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; the Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA; the Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA; the Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; the Stanford Genome Technology Center, Stanford University, Palo Alto, CA, USA; the European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany; the Department of Chemical Engineering, Stanford University, Stanford, CA, USA; the Stanford ChEM-H, Stanford University, Stanford, CA, USA; the Department of Immunology, Oslo University Hospital, Oslo, Norway; the Department of Bioengineering, University of Washington, Seattle, WA, USA; and the Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA.

Celiac.com 04/18/2022 - Several observational studies have indicated that celiac disease patients do not have higher susceptibility of COVID-19 and the risk of severe COVID-19. However, the the conclusions of such studies can be distorted by reverse causation and confounding, especially for newly-emerged diseases, such as COVID-19. A team of researchers recently set out to further clarify the picture using both observational and Mendelian Randomization analysis. The research team included Jiuling Li, Aowen Tian, Dandan Yang, Miaoran Zhang, Lanlan Chen, Jianping Wen, and Peng Chen. For their observational study, the team used data from the UK Biobank cohort. They conducted both univariate and multivariate logistic regression analysis to identify the risk factors for both COVID-19 susceptibility and severe COVID-19. They also conducted a two-sample Mendelian Randomization analysis to delineate causality between celiac disease and COVID-19 susceptibility and severe COVID-19. The good news is that the team's UK Biobank data revealed that celiac disease patients had a slightly lower overall susceptibility to COVID-19, and that celiac patients did not have higher rates of severe COVID-19. Meanwhile, the Mendelian Randomization study showed that celiac patients had lower susceptibility to both COVID-19 and fewer cases of severe COVID-19, although the lower COVID-19 susceptibility is seen in only in the UK Biobank cohort. These results indicate that people with celiac disease do not face higher risk of getting COVID-19, or of developing severe COVID, than the non-celiac population, and they likely do not need to take any extra COVID-19 precautions. Read more in Clin Transl Gastroenterology The researchers in this study are variously affiliated with the Department of Pathology, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Experimental Center of Pathogenobiology, Immunology, Cytobiology and Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China; the Clinical Medicine of Jilin University in Changchun, Jilin, China; and the Department of Genetics, College of Basic Medical Sciences, Jilin University in Changchun, Jilin, China.

Celiac.com 02/14/2022 - Prior studies have found links between the gut microbiome and COVID-19, along with other diseases. However, a new study by investigators at the Chinese University of Hong Kong offers the first published data specifically linking gut health to COVID's long-term effects. The research team assessed 106 patients with COVID-19 from February to August 2020, at three different hospitals, and compared their results against a group of patients recruited in 2019, who did not have COVID. Patients had mostly mild to moderate Covid severity. At 3 months, nearly ninety of the COVID patients had post–acute COVID-19 syndrome (PACS), which researchers defined as at least one persistent, otherwise unexplained symptom 4 weeks after testing negative for Covid. After six months, more than eighty patients still had PACS, with the main complaints being anxiety, fatigue, poor memory, hair loss, and difficulty sleeping. Stool sample analysis of PACS patients showed sharply lower bacteria diversity and abundance at six months, compared with with control subjects, and those without PACS. In patients with PACS, at both baseline and follow-up, nearly thirty bacteria species were reduced, while nearly fifteen were increased. Patients with COVID but not PACS showed just 25 changes to bacteria species at hospital intake, and all of those patients normalized by 6 months. The team linked patient respiratory symptoms at 6 months to higher levels of opportunistic pathogens such as Streptococcus anginosus and S. vestibularis. They also tied neuropsychiatric symptoms and fatigue to nosocomial pathogens, which are linked to opportunistic infections, such as Clostridium innocuum and Actinomyces naeslundii (P < .05). Bacteria that produce the beneficial fatty acid butyrate were substantially reduced in patients with hair loss. They also found that specific bacteria, including Bifidobacterium pseudocatenulatum and Faecalibacterium prausnitzii, showed the greatest inverse correlations with PACS at 6 months.. "Particular gut microbial profiles may indicate heightened susceptibility," said Dr Siew Ng, MBBS, PhD, associate director at the university's Center for Gut Microbiota Research. "Although the findings were drawn from patients with earlier strains of the COVID-19 virus, the findings still apply to new variants, including Omicron, since these pose the same problem of persistent disruption of the immune system," Ng adds. Dr Ng's group is currently carrying out trials to assess how long COVID might be prevented, and antibodies boosted, by modulating the microbiome after vaccination in high-risk people. "To our knowledge, this is the first study to show that altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus," said Dr Ng. Meanwhile, Eugene Chang, MD, professor of medicine at the University of Chicago, who has studied the gut microbiome and gastrointestinal disease, cautions that the study is "too preliminary" to lead to any clinical changes. Dr. Chang notes that the observations merely identify the microbes present, not their actual effects. Stay tuned for more on this and related stories about celiac disease and Covid. Read more in Medscape Medical News

Celiac.com 12/20/2021 - Janet and Maku Game of Edmonton, Canada arrived in Toronto early on Dec. 4. Because Maku had traveled to South Africa within the 14 day window set by Canadian authorities, the pair were ordered to quarantine until they received a negative COVID-19. They ended up stuck in a quarantine nightmare with no gluten-free food for Janet for nearly two days. Concerns about the rapidly spreading Omicron variant, have led Canadian authorities to require that anyone who has traveled to South Africa within 14 days remain in quarantine until they receive a negative COVID-19 test, even those who are already vaccinated. According to recent reports, Maku has had three doses of the COVID-19 vaccine and Janet has had two doses. Janet said she has severe celiac disease and her food must be 100% gluten-free or she will suffer great pain and diarrhea. Maku said they told the Hilton hotel about the dietary restriction when they first arrived. The pair had eaten before arriving at the hotel for quarantine, but they received no dinner that night, and no meal the next morning, Dec. 5th. Lunch, their first meal, was a dish of rice and vegetables, and a single portion of crispy chicken that was not gluten-free. They couple reported that Red Cross Canada is only one point of contact at the hotel, but that no one was on staff at reception. They wanted to get some proper food, as Janet was nursing a broken leg she injured in Africa, and drinking sugary drinks to keep her energy up. They tried calling Red Cross at least five times throughout Dec. 5 and said they were on hold for up to an hour before getting in touch with someone. Around 9:40 p.m. that night, Janet received a banana and apple, followed by a gluten-free bagel the next morning a little before 9 a.m. on the 6th. By that time, she had gone 41 hours without a proper meal. “I just want to go home,” Janet told reporters for Global News. “I’m extremely tired and extremely exhausted.” Under the quarantine rules, the Games were not allowed to leave their room or receive any food orders, such as from Uber Eats or from their relatives who live nearby. “It’s so scary,” Janet said of the hotel atmosphere. “You can’t see anybody. They put wall-to-wall plastic...It’s like a science-fiction world here.” After receiving a negative COVID-19 test result after pushing the lab to expedite their results, they were still waiting for public health to give them the go-ahead as of Monday at noon to be able to board a flight back to Edmonton, where they have lived for 20 years. Being stuck in a situation where you cannot order or received food, and can only get what you're given by those in charge, and trying not to starve as they fumble in trying to get you something gluten-free is a true nightmare for most people with celiac disease. Read more at GlobalNews.ca

Celiac.com 12/27/2021 - To better understand the rates of hospitalization, mortality, thrombosis or intensive care unit (ICU) treatment in individuals with celiac disease and COVID-19, a team of researchers recently set out to assess the clinical characteristics, hospitalization and mortality rates of COVID-19 among U.S. celiac disease patients. The research team included Emad Mansoor, Muhammed Mustafa Alikhan, Jaime Abraham Perez, Kayla Schlick, Mohannad Abou Saleh, and Dr Alberto Rubio-Tapia. They are variously affiliated with the Department of Medicine; Digestive Health Institute, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Department of Medicine, University Hospitals of Cleveland, Cleveland, Ohio, USA; the Center for Clinical Research, Case Western Reserve University, Cleveland, Ohio, USA, Department of Medicine; the Division of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA. The team notes that their work was sparked, in part, by Belli et al1 regarding outcomes of COVID-19 in liver transplant candidates. The authors in Belli et al concluded that liver transplant candidates were at risk of early death, especially those with decompensated cirrhosis and model for end-stage liver disease score of 15 or above. That research team reviewed clinical outcomes in celiac patients after a diagnosis of COVID-19. Although the evidence of COVID-19's impact of other chronic disorders is emerging, researchers still don't know very much about the consequences of COVID-19 infection in people with celiac disease. To compile the celiac disease cohort, the team used the TriNetX healthcare research network to compile the electronic medical records of adults with celiac disease, and confirmed COVID-19 infection, from 51 healthcare organizations in the USA, between 1 January 2020 and 7 July 2021. For the non-celiac disease cohort, they also identified COVID-19 positive patients, with no history of celiac disease, from the same time period. They defined celiac disease by the International Classification of Disease, 10th Revision (celiac disease-10) diagnostic code and related codes, such as villous atrophy present on biopsy of small intestine and positive autoantibody screening. For both groups, the team studied the risk of hospitalization, mortality, thrombosis, and ICU requirement within 90 days of COVID-19 diagnosis. They also performed 1:1 propensity score matching using a greedy nearest-neighbor matching algorithm to account for potential confounding variables. Overall, the researchers found no significant differences among any of the measured outcomes in those with celiac disease, compared with non-celiac patients with COVID-19, after propensity score matching. Understanding more about COVID-19 outcomes of patients with celiac disease will researchers and patients to get a better idea of any potential concerns or options, and potentially lead to better outcomes. Read the full findings in Gut. Reference: Belli LS, Duvoux C, Cortesi PA, et al. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021;70:10.1136/gutjnl-2021-324879:1914–24. doi:10.1136/gutjnl-2021-324879

Celiac.com 10/04/2021 - How symptoms and antibodies related to SARS-CoV-2 infection develop in patients with celiac disease is unclear. Is it similar to non-celiacs? A team of researchers recently set out to investigate the impact of SARS-CoV-2 infection in celiac patients. The team asked celiac disease patients about how their COVID-19 symptoms developed, how they were complying with anti-virus measures and, how strictly they were following a gluten-free diet. The team compared data on the rates of anti-SARS-CoV-2 IgG and IgA (anti-RBD and N proteins) in celiacs with data for non-celiacs. They also looked at expression of the duodenal ACE2 receptor. Where possible, they analyzed data on duodenal histology, anti-tissue transglutaminase IgA (tTGA), comorbidities and GFD adherence. The team looked at a total of 362 celiac patients, 42 of which reported COVID-19 symptoms (12%), with 21% of these symptomatic patients testing positive for anti-SARS-CoV-2 Ig. Overall, 18% of celiac patients showed anti-SARS-CoV-2 Ig compared with 25% of the control group. Celiac patients had significantly lower levels of anti-N IgA. Symptoms and/or antibodies were not affected by tTGA, duodenal atrophy, gluten-free diet adherence, or other comorbidities. They did detect ACE2 receptor in the non-atrophic duodenal mucosa of patients; which, is associated with atrophy at lower levels. Except for anti-N IgA, celiac disease patients have an anti-SARS-CoV-2 Ig profile similar to non-celiacs. The team found no risk factors tied to celiac disease parameters or gluten-free diet adherence. Read more in Digestive and Liver Disease The research team included Luca Elli; Federica Facciotti; Vincenza Lombardo; Alice Scricciolo; David S. Sanders; Valentina Vaira; Donatella Barisani; Maurizio Vecchi; Andrea Costantino; Lucia Scaramella; Bernardo dell'Osso; Luisa Doneda; and Leda Roncoroni. They are variously affiliated with the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; the European Institute of Oncology IRCCS; the Centre for Prevention and Diagnosis of Celiac Disease; the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; the School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; the Pathology Unit, and the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; and the Centre for Prevention and Diagnosis of Celiac Disease.

Celiac.com 05/10/2021 - A top physician in Turkey recently warned that rates of autoimmune diseases like Type 1 diabetes and celiac will likely rise in the wake of the coronavirus pandemic. Autoimmune diseases, including thyroid issues, happen when the body attacks its own tissues. The coronavirus causes the body's immune system to produce “attacking” antibodies. Because "[v]iruses serve as a mechanism that pull the trigger for autoimmune diseases,” an increase in rates of autoimmune diseases was unavoidable after a year of pandemic," says Professor Tufan Tükek, head of the Faculty of Medicine at Istanbul University. Lingering COVID-19 symptoms Impede Autoimmune Disease Management Ongoing coronavirus symptoms have been a problem for numerous recovered patients, and can impair the management of autoimmune diseases. For example, in diabetes patients, studies show that the symptoms influence blood sugar levels, and impede its management by causing fatigue and memory issues. In March 2020, Istanbul University became one of the first institutions in the country to establish an observation center for recovered coronavirus patients. Since then, they have monitored nearly 4,000 patients. Professor Tükek says that, in the early days of the pandemic, diarrhea was the main "long COVID-19" symptom, and then, after a second COVID-19 wave last summer, their team began seeing more memory issues and hair loss. Lately, Tükek said, they are seeing more cases of blood clots. COVID-19 Symptoms Can Linger for Months Dr. Huzeyfe Arıcı, a physician working at the observation center, said that COVID-19 symptoms can linger for up to eight weeks, in many cases. “We have patients suffering from back pain that long, something that cannot be cured by painkillers. We also see an increasing number of cases with memory lapses,” he stressed. With COVID-19 survivors numbering in the millions, it is an open question as to how many will be affected by lingering symptoms, for how long, and what can be done to help them. The idea that coronavirus could increase rates of diabetes, celiac or other autoimmune conditions is bit alarming. Quantifying and describing the problems and then creating a way to address them is crucial. Look for more information as other observation centers share their observations on COVID-19 survivors. Read more in Dailysabah.com

Celiac.com 03/15/2021 - COVID-19 is mainly a respiratory illness, but there is mounting evidence to indicate that the gut and gut microbiota may play a role in the disease. A team of researchers recently set out to determine if the gut microbiome is linked to disease severity in patients with COVID-19, and whether variations in microbiome composition might resolve with the passing of the SARS-CoV-2 virus. The research team included Yun Kit Yeoh, Tao Zuo; Grace Chung-Yan Lui; Fen Zhang; Qin Liu; Amy YL Li; Arthur CK Chung; Chun Pan Cheung; Eugene YK Tso; Kitty SC Fung; Veronica Chan; Lowell Ling; Gavin Joynt; David Shu-Cheong Hui; Kai Ming Chow; Susanna So Shan Ng; Timothy Chun-Man Li; Rita WY Ng; Terry CF Yip; Grace Lai-Hung Wong; Francis KL Chan; Chun Kwok Wong; Paul KS Chan; and Siew C Ng. To get the answers, the team reviewed blood, stool and patient records from 100 patients with laboratory-confirmed SARS-CoV-2 infection, from two different hospitals. They collected serial stool samples from 27 of the 100 patients up to 30 days after the resolution of SARS-CoV-2. They assessed gut microbiome composition by shotgun sequencing total DNA from stool extraction. They then measured plasma concentrations of inflammatory cytokines and blood markers. Compared with non-COVID-19 patients, those with COVID-19 showed a substantially changed gut microbiome, whether or not they received medication. In COVID-19 patients, a number of gut microbiota with known immunomodulatory potential, such as Faecalibacterium prausnitzii, Eubacterium rectale and bifidobacteria were low, and remained low up to 30 days after Covid-19 abated. In these cases, Covid-19 severity reflected elevated concentrations of inflammatory cytokines and blood markers such as C reactive protein, lactate dehydrogenase, aspartate aminotransferase and gamma-glutamyl transferase. The connections between gut microbiota composition, levels of cytokines and inflammatory markers in patients with COVID-19 suggest that gut microbiota composition reflects disease severity and weakened immune responses. Moreover, because gut microbiota imbalance after Covid-19 resolution may lead to persistent symptoms, it is important to understand how gut microorganisms are involved in inflammation and COVID-19. Read more in Gut The researchers are variously affiliated with the Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong; the Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; the State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong; the Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong; the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong; the Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong; the Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.

Celiac.com 06/16/2021 - Weeks after SARS-CoV-2 infection or exposure, some children develop a severe, life-threatening illness called Multisystem Inflammatory Syndrome in Children (MIS-C). A new study offers hope for diagnosis, treatment and prevention of MIS-C. Gastrointestinal symptoms are common in MIS-C patients and severe hyperinflammatory response ensues with potential for cardiac complications. The cause of MIS-C has not previously been identified. A team of researchers recently set out to learn more about diagnosing, treating, and preventing MIS-C. The research team analyzed specimens from 19 children with MIS-C, 26 with acute COVID-19, and 55 control subjects and assessed stool samples for SARS-CoV-2 by RT-PCR, and plasma samples for markers of breakdown of mucosal barrier integrity, including zonulin. They used ultra-sensitive antigen detection to probe for SARS-CoV-2 antigenemia in plasma, and then characterized the resulting immune responses. As proof of concept, we treated a MIS-C patient with larazotide, a zonulin antagonist, and monitored impact on antigenemia and clinical response. The team demonstrated that, in MIS-C patients, prolonged presence of SARS-CoV-2 in the GI tract leads to the release of zonulin, an intestinal permeability biomarker, which causes SARS-CoV-2 antigens to flow into the bloodstream, and triggers hyperinflammation. The one MIS-C patient treated with larazotide, a drug which is currently in clinical trials as a possible treatment for celiac disease, showed a coinciding decrease in plasma SARS-CoV-2 Spike antigen levels, inflammatory markers, along with clinical improvement above that resulted from presently available treatments. The team's data detailing the pathogenesis of MIS-C offers insight into targets for diagnosing, treating, and preventing MIS-C, which are crucial to addressing this increasingly common severe COVID-19-related disease in children. Read more at The Journal of Clinical Investigation. The research team included Lael M. Yonker, Tal Gilboa, Alana F. Ogata, Yasmeen Senussi, Roey Lazarovits, Brittany P. Boribong, Yannic C. Bartsch, Maggie Loiselle, Magali Noval Rivas,4 Rebecca A. Porritt,4 Rosiane Lima,1 Jameson P. Davis, Eva J. Farkas, Madeleine D. Burns, Nicola Young, Vinay S. Mahajan, Soroush Hajizadeh, Xcanda I. Herrera Lopez,5 Johannes Kreuzer, Robert Morris, Enid E. Martinez, Isaac Han, Kettner Griswold Jr., Nicholas C. Barry, David B. Thompson, George Church, Andrea G. Edlow, Wilhelm Haas, Shiv Pillai, Moshe Arditi, Galit Alter, David R. Walt, and Alessio Fasano. They are variously affiliated with the Department of Pediatrics, Massachusetts General Hospital, Boston, United States of America; the Department of Pathology, Brigham and Women’s Hospital, Boston, United States of America; the Department of Medicine, Ragon Institute of MGH, MIT and Harvard, Cambridge, United States of America; the Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, United States of America; the Department of Medicine, Massachusetts General Hospital, Boston, United States of America; the Department of Immunology, Wyss Institute for Biologically Inspired Engineering, Boston, United States of America; the Department of Genetics, Harvard Medical School, Boston, United States of America; the Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, United States of America; the Massachusetts General Hospital, Boston, United States of America; the Department of Immunology, Massachusetts General Hospital, Boston, United States of America; and the Department of Pathology, Harvard Medical School, Boston, United States of America.