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Celiac.com 11/11/2014 - There have been claims that certain strains of wheat, especially ancient strains, such as einkorn, do not trigger adverse reactions in people with celiac disease, or that they trigger less severe reactions. Until now, researchers haven't been able to say for certain that celiac disease patients react adversely to all varieties of wheat, or whether there may be differences in reactions to certain strains. A research team recently evaluated the safety of ancient strains of wheat in celiac disease. The researchers included Tanja Šuligojemailemail, Armando Gregorinidemail, Mariastella Colombaeemail, H. Julia Elliscemail, and Paul J. Ciclitirac To get a better idea of the nature of celiac factions to wheat, the team studied seven Triticum accessions showing different origin (ancient/modern) and ploidy (di-, tetra- hexaploid). In all, they tested ancient Triticum monococcum precoce (AA genome) and Triticum speltoides (BB genome), accessions of Triticum turgidum durum (AABB genome) including two ancient (Graziella Ra and Kamut) and two modern (Senatore Cappelli and Svevo) durum strains of wheat and Triticum aestivum compactum (AABBDD genome). They evaluated small intestinal gluten-specific T-cell lines generated from 13 celiac patients with wheat accessions by proliferation assays. They found that all strains of wheat they tested triggered a range of adverse responses, independent of ploidy or ancient/modern origin. Based on these results, they suggest that all strains of wheat, even ancient strains previously suggested to be low or devoid of celiac toxicity, should be tested for immunogenicity using gluten-specific T-cell lines from multiple celiac patients rather than gluten-specific clones to assess their potential toxicity. They also emphasize the need for celiac patients to follow a strict gluten-free diet, including avoidance of ancient strains of wheat. Source: Clin Nutr. 2013 Dec;32(6):1043-9. doi: 10.1016/j.clnu.2013.02.003

Celiac.com 02/28/2017 - A number of commercial brewers are opting to use enzymatic digestion, or hydrolysis, for treating gluten-containing foods and beverages to make them safe for people with gluten sensitivity, including those with celiac disease. However, some have questioned whether the process is safe for all people with celiac disease, as some celiacs complain that they experience gluten sensitivity when they drink these beers. Currently, there are no validated testing methods for quantifying levels of hydrolyzed or fermented gluten peptides in foods and beverages that might be harmful to celiac patients. This makes it difficult to determine the safety of hydrolyzed products for people with celiac disease. Some researchers finally tested the clinical response by celiac patients to gluten-free beer, gluten-removed beer, and conventional beer. They also tested a non-celiac control group. Their main goal was to determine if sera from active celiac patients can serve as an effective detection tool for residual celiac-reactive proteins in gluten-removed beer. The research team included Laura K Allred; Katherine Lesko; Diane McKiernan; Cynthia Kupper; and Stefano Guandalini. Their study used an ELISA-based method to determine whether serum antibody binding of residual peptides in a fermented barley-based product is greater among active-celiac disease patients than a normal control group, using commercial beers as a test case. The team first gathered sera from 31 active-celiac disease patients and 29 non-celiac control subjects, then assessed the binding of proteins from barley, rice, traditional beer, gluten-free beer, and enzymatically treated (gluten-removed) traditional beer. None of the 29 non-celiac control subjects reacted to all three barley-based samples (barley extract, traditional beer, and gluten-removed beer), while 2 of 31 active-celiac disease patients (6.4%) responded to all three samples. In the ELISA, none of the subjects' sera bound to proteins in the naturally gluten-free beer. Eleven active celiac patients showed immunoglobulin A (IgA) or immunoglobulin G (IgG) binding to a barley extract, compared to only one non-celiac control subject. Of the seven active celiac patients who had an IgA binding response to barley, four also responded to traditional beer, while two of these also responded to the gluten-removed beer. None of the sera from non-celiac control subjects bound to all three beer samples. Breaking down the results, only 11 of the 31 active celiac disease patients even reacted to barley. Only 4 of those 11 reacted to traditional beer; a mere 12%. Of those, only two celiacs reacted to gluten-removed beer, or about 6% of the test group. So, interestingly, while this study indicates that the vast majority of people with celiac disease seem to tolerate both traditional and gluten-free beers, it also indicates that there are residual peptides in the gluten-removed beer that may trigger reactions in a minority of celiacs. This particular study was small and highly regional, so very little can be projected to the larger celiac population. Clearly more study is warranted to more accurately determine the exact nature of the risk for celiacs who drink gluten-removed beer. This isn't the last we'll hear about the safety of gluten-removed beer. Stay tuned for more on this and other gluten-free stories. Read more about gluten-free and gluten-removed beers. Source: Journal of AOAC International. DOI: https://doi.org/10.5740/jaoacint.16-0184

Celiac.com 07/31/2014 - Although the adverse mucosal reaction in celiac disease occurs mainly in the small intestine, other mucosal surfaces in the gastrointestinal tract and the gut-associated lymphoid tissue are also affected. To better understand the impact, a research team recently set out to examine histopathological findings in the oral mucosa of celiac disease patients. Specifically, based on the assumption that the oral mucosa could reflect the histopathological intestinal inflammation seen in celiac disease patients, they wanted to determine the pattern of T-cell subsets in the oral mucosa of young adults with celiac disease. The research team included E. Bardellini, F. Amadori, A. Ravelli, M. Salemme, S. Lonardi, V. Villanacci, and A. Majorana. For their study, they enrolled a group of 37 patients with celiac disease, ranging in age from 20-38 years. Twenty-eight were female, nine male. The team broke the 37 subjects into two groups. The nineteen patients of group A were following a gluten free diet (GFD); two patients for less than one year; 6 patients between 1 and 5 years; 11 patients more than 5 years. The 18 patients (group remained untreated. Meanwhile, fifteen healthy volunteers (age range 18-35 years, 11 females and 4 males served as controls. Because the study involved observing untreated celiac patients, the team sought and received ethical approval for the research from the Ethics Committee. The team took biopsy specimens from normal looking oral mucosa. They conducted immunohistochemical investigation with monoclonal antibodies to CD3, CD4, CD8, and gamma/delta-chains T cell receptor (TCR). They found T-lymphocytic inflammatory infiltrate significantly higher in group B (p < 0.0001); as compared with group A and with the control group. Their results confirm that the oral cavity is involved with adverse reactions to celiac disease triggers, and might offer potential for celiac diagnosis. Source: Rev Esp Enferm Dig. 2014 Feb;106(2):86-91.

Celiac.com 02/27/2014 - For many people with celiac disease, one of the numerous downsides of the condition is the constant threat of an adverse reaction triggered by accidental gluten consumption. Because reactions to gluten ingestion can be severe for some celiac patients, many clinicians are looking to see if anything can be done to lessen the effects gluten reactions in celiac patients once they have started. A team of researchers sought to provide at least one possible answer by looking into the safety and efficacy of Aspergillus niger prolyl endoprotease (AN-PEP) to lessen effects gluten reactions in celiac patients. The researchers included G.J. Tack, J.M. van de Water, M.J. Bruins, E.M Kooy-Winkelaar, J. van Bergen, P. Bonnet, A.C. Vreugdenhil, I. Korponay-Szabo, L. Edens, B.M. von Blomberg, M.W. Schreurs, C.J. Mulder, and F. Koning. They are all affiliated with the Department of Gastroenterology and Hepatology, VU University Medical Centre, 1007 MB Amsterdam, The Netherlands. For their study, the team enrolled 16 adults with celiac disease as confirmed by positive blood test and biopsy-confirmed subtotal or total villous atrophy. All patients were following a strict gluten-free diet, and showed normalized antibodies and mucosal healing classified as Marsh 0 or I. In their randomized double-blind placebo-controlled pilot study, the team had patients consume wheat toast, totaling about 7 grams of gluten per day, with AN-PEP for a two-week safety phase. After a two-week washout period with adherence of the usual gluten-free diet, 14 patients were randomized to receive gluten with either AN-PEP or placebo for there two-week efficacy phase. Baseline measurements included complaints, quality-of-life, serum antibodies, immuno-phenotyping of T-cells and duodenal mucosa immuno-histology. The team collected both serum samples and quality of life questionnaires during and after the safety, washout and efficacy phase. They conducted duodenal biopsies after both safety and efficacy phases. The primary endpoint was a change in histological evaluation according to the modified Marsh classification. None of the sixteen adults in the study suffered serious adverse events, and no patients withdrew during the trial. Overall scores for the gastrointestinal subcategory of the celiac disease quality (CDQ) remains fairly high throughout the study, indicating that AN-PEP was well tolerated. Through the efficacy phase, CDQ scores for patients consuming gluten with placebo or gluten with AN-PEP remained largely unchanged, and researchers observed no differences between the groups. Moreover, neither the placebo group nor the AN-PEP group developed significant antibody titers, and IgA-EM concentrations remained negative for both groups. The team excluded two patients from entering the efficacy phase because their mucosa showed an increase of two Marsh steps after the safety phase, even though their serum antibodies remained undetectable. A total of 14 patients were considered histologically stable on gluten with AN-PEP. Also after the efficacy phase, the team saw no significant deterioration in immunohistological and flow cytometric values between the group consuming placebo compared to the group receiving AN-PEP. Furthermore, compared to baseline, after two weeks of gluten four out of seven patients on placebo showed increased IgA-tTG deposit staining. In the seven patients receiving AN-PEP, one patient showed increased and one showed decreased IgA-tTG deposits. AN-PEP appears to be well tolerated. However, the primary endpoint was not met due to lack of clinical deterioration upon placebo, impeding an effect of AN-PEP. Source: World J Gastroenterol. 2013 Sep 21;19(35):5837-47. doi: 10.3748/wjg.v19.i35.5837.

Celiac.com 12/03/2010 - An interesting finding regarding corn from a research team based in Sweden that studied the effects of both gluten and corn on patients with celiac disease. The research team included G. Kristjánsson, M. Högman, P. Venge, R. and Hällgren, who are affiliated variously with the Department of Gastroenterology, the Department of Medical Cell Biology, Section of Integrative Physiology, the Laboratory for Inflammation Research, and the Department of Rheumatology at Uppsala University Hospital in Uppsala, Sweden. Specifically, the team sought to better understand the facets of nitric oxide (NO) production induced by rectal gluten challenge and the relationship between nitric oxide production and mucosal granulocyte activation. The team measured the release of rectal nitric oxide in 13 patients with celiac disease and in 18 control subjects. The team measured levels both before and after rectal wheat gluten challenge. To collect the gas, the team used a rectal balloon and a newly developed instrument, which allows simultaneous measurements of concentrations of granulocyte mediators in the rectal mucosa. This new technique is called the “mucosal patch technique”. The technique allowed the team to measure myeloperoxidase (MPO), eosinophil cationic protein (ECP), and histamine. They found that concentrations of rectal nitric oxide increased in ALL celiac patients after wheat gluten challenge, peaking at 15 hours (average concentrations of 9464 (SEM 2393) parts per billion (ppb), with a range of 250–24982 ppb. The maximum MPO and ECP increase occurred five hours after challenge. At the fifteen hour mark, the team observed a correlation between mucosal MPO and nitric oxide production. They then compared their results against measurements taken after corn gluten challenge. Six of the celiac patients showed an increase in nitric oxide production 15 hours after rectal corn gluten challenge, though much smaller than after gluten challenge. The control group showed no increases after either challenge. The main findings showed that mucosal activation of neutrophils and eosinophils precedes pronounced enhancement of mucosal nitric oxide production after rectal wheat gluten challenge in patients with celiac disease. The researchers also found that some patients with celiac disease show signs of an inflammatory reaction after rectal corn gluten challenge, shown by increased nitric oxide production and activation of granulocyte markers. The fact that nearly half of the celiac patients in this small sample showed increases in nitric oxide production after a corn challenge is definitely interesting, and calls out for further study. Source: Gut 2005;54:769-774. doi:10.1136/gut.2004.057174 Update by Elaine E. Thompson, Ph.D. submitted 12/03/2010: In this study the researchers discovered that the cornmeal they tested was contaminated with wheat. Please revise this blog entry to reflect the flaw in the study."The manufacturer claimed that their corn product was free from wheat or other cereals. We tested the product at the Swedish National Food Administration (Livsmedelsverket) and it was found to be contaminated with 82 μg/g (ppm), which is less than the usual allowed amount in a gluten free diet (<200 ppm) according to the Codex Alimentarius Standard for gluten free foods, and far less than what has been found to be a safe amount of gluten contamination when correlated with histology in oral challenge studies. It cannot be excluded that the small amounts of gluten present in the corn preparation induced an inflammatory reaction as the mucosal patch technique is very sensitive. "