The mystery of coeliac disease has been cracked by scientists, paving the way for treatments for the condition that blights the lives of millions of people.
The intolerance to gluten, the main protein in wheat, rye and barley, causes the immune system to attack the gut.
Now British and Australian scientists have pinpointed why the protein can be so toxic.
The volunteers were asked to eat bread, rye muffins or boiled barley. Six days later they had blood samples taken to measure their immune response to thousands of different gluten fragments, or peptides.
Wheat, rye and barley all contain gluten
The tests identified 90 peptides that caused some level of immune reaction, but three were found to be particularly toxic.
Professor Bob Anderson, head of the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, said: “These three components account for the majority of the immune response to gluten that is observed in people with coeliac disease.”
Coeliac disease can be managed with a gluten-free diet but this is often a challenge for patients. Nearly half still have damage to their intestines five years after starting a gluten-free diet.
Professor Anderson said one potential new therapy is already being developed, using immunotherapy to expose people with coeliac disease to tiny amounts of the three toxic peptides.
Early results of the trial are expected in the next few months.
* Coeliac disease is an autoimmune disease
* Gluten found in wheat, barley and rye triggers an immune reaction in people with coeliac disease
* This damages the lining of the small intestine
* Other parts of the body may be affected
* Source: Coeliac UK
The symptoms of coeliac disease vary from person to person and can range from very mild to severe.
Possible symptoms include diarrhoea, nausea and vomiting, recurrent stomach pain, tiredness, headaches, weight loss and mouth ulcers.
Some symptoms may be mistaken as irritable bowel syndrome or wheat intolerance.
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July 26th, 2010 at 2:57 pm
Nearly one in four people suffering from gluten intolerance visited their doctor for a decade or more before receiving an accurate diagnosis, research has revealed today.
Some 23 per cent consulted their doctor about their symptoms for over a decade, while a further 11 per cent asked their doctor for help for over 20 years.
Coeliac disease can lead to diarrhoea, bloating and abdominal pain and is caused by the body’s immune system mistaking gluten for a foreign organism.
Gluten is a protein found in a number of grains including wheat, barley and rye, and sufferers should avoid pasta, cakes, breakfast cereals and most types of bread.
If left untreated, coeliac disease – which affects about one in every 100 people in the UK – can cause osteoporosis, growth defects and infertility.
November 20th, 2010 at 9:47 pm
“The precise cause of the immune reaction that leads to coeliac disease has been discovered,” BBC News reported. It said that three key substances in gluten have been found to trigger the condition, and researchers believe them to be a potential new target for developing treatments and possibly a vaccine.
These researchers asked 200 volunteers with coeliac disease to eat bread, rye muffins or boiled barley, all of which contained gluten. They then measured the volunteers’ immune response to thousands of different peptides (gluten fragments) six days later. Among 90 possible peptides, three were found to be particularly toxic.
This research appears to have been carefully carried out and is well reported. These are important findings and show some promise in the search for a treatment for coeliac disease. Early clinical trials are reportedly already underway, testing whether a compound containing these three peptides can stimulate an immune reaction. The full implications will not be known until after these trials are complete.
Where did the story come from?
The study was carried out by researchers from Australia, the UK and Italy. It was partly funded by the National Health and Medical Research Council (NHMRC), the Coeliac Research Fund in Australia and several other institutions in Europe. The study was published in the peer-reviewed journal Science Translational Medicine.
Both the Daily Mail and the BBC accurately reported the main details and implications of this complex laboratory study.
What kind of research was this?
Coeliac disease is a common digestive condition in which a person is intolerant (has an adverse reaction) to gluten, a protein present in wheat, barley and rye, and which can be found in pasta, cakes and most types of bread. People with the condition can have a wide range of symptoms when exposed to gluten, including diarrhoea, bloating and abdominal pain, and the severity of the symptoms can range from very mild to severe.
These symptoms are caused by the immune system mistaking gluten for a hostile organism, such as a virus. The immune system attacks the gluten, which can lead to the small intestine becoming damaged.
The researchers explain that the response of CD4+ T cells to gluten is what initially causes the immune response. The T cells are triggered when they encounter the peptides (simple chemical compounds) derived from gluten. Identifying the type of peptides that cause the greatest immune response (known as epitopes) may aid the development of new treatments. One such potential treatment is immunotherapy, where the body is repeatedly exposed to the toxins that cause the immune response, eventually making the body accustomed to them. The researchers say this method has reportedly been successful in mouse models of diseases caused by T cells.
The laboratory research was complex, but does appear to have shown a clear direction for future research. The researchers say that a peptide-based immunotherapy can be designed and tested for this condition and that the lead compound (the three immunogenic gluten peptides) is now in phase I clinical trials.
What did the research involve?
The researchers recruited 226 volunteers with coeliac disease from Oxford and Melbourne. The average age of the volunteers was 50 years and 73% were women. A control group of healthy volunteers of a similar age was also selected.
The participants were asked to take part in a number of ‘oral grain challenges’, in which they ate slices of wheat bread, barley risotto, rye muffins or a combination of these over three days. People with coeliac disease took part in 226 of these challenges, and the healthy volunteers took part in 10.
Overall, 113 challenges tested wheat, 41 tested barley, 43 tested rye and 29 tested all three grains combined. It is not clear if each volunteer was tested with more than one grain.
At the time of the challenge, the volunteers with coeliac disease had been strictly gluten-free for three months or more, and the healthy volunteers for four weeks. The challenges were designed to induce an immune response in the volunteers, where their bodies produced gluten-specific T cells. The researchers then analysed these cells from blood samples to identify which peptides they could recognise.
At the start of the study and after six days, blood was taken for analysis, with the total volume collected on both occasions not exceeding 300ml.
What were the basic results?
The blood samples showed that particular cereals and grains resulted in the specific peptides which then stimulated the T cells. Three peptides for the three grain/cereal types.
However, when they looked at the challenge when all grains were taken together, a specific sequence from peptides found in wheat and barley seemed to be the main epitope responsible for the immune response. This meant they thought these two were “dominant” regardless of the grain consumed.
The researchers also say that just three peptides accounted for most of the T cells that responded to gluten ingestion and that once these were taken into account other gluten peptides became less important.
How did the researchers interpret the results?
The researchers say that their findings show that T cells, a cause of coeliac disease, are similar in terms of the peptides they recognise and therefore a peptide-based therapy for this disease should be possible.
Conclusion
This research appears to have been carefully carried out and is well reported. These are important findings and show some promise in the search for a treatment for coeliac disease. Early clinical trials are reportedly already underway, testing whether a compound containing these three peptides can stimulate an immune reaction. The full implications will not be known until after these trials are complete.
December 3rd, 2010 at 6:52 am
New food labelling rules have been published today to help people who are intolerant to gluten. Under new European Union Regulations, two types of labelling on packets will be adopted:
* *gluten-free * : for foods containing less than 20 parts of gluten per million
* very low gluten : for foods containing less than than 100 parts of gluten per million
Previously, a food labelled ‘gluten free’ could have contained up to ten times of that allowed under the new regulations.
The introduction of just two types of labelling is meant to minimise consumer confusion in this area and help people with coeliac disease (who are intolerant to gluten) to make safe and informed choices about the types of food they eat.
Sue Hattersley, head of food allergy policy at the Food Standards Agency, said:
‘Around one per cent of people in the UK are intolerant to gluten, and packaging claims about gluten in foods are very important to these people. The number of products marketed to them is increasing rapidly. Without rules controlling the levels of gluten in them, the amounts of gluten could vary greatly, which could cause serious health problems.
‘The new lower limit of 20 parts in a million means greater peace of mind for people with a gluten intolerance, as they can be sure that foods sold as ‘gluten free’ do not contain levels that could be harmful to them.’
Manufacturers can use the new labelling system immediately, but in order to give them time to adapt to the new rules by reformulating products or changing existing packaging, products do not have to comply with the new rules until 1 January 2012.
Sourced from the UK Foods Standards Agency