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A new virus has been added to the list of potential reasons celiac disease develops

By Amy Ratner, Medical and Science News Analyst

Another virus has been added to the list of common viral infections suspected as possible reasons celiac disease develops, according to a new study.

Researchers from Norway, Sweden and the Czech Republic found that a higher frequency of enterovirus during early childhood was associated with later development of celiac disease in a study published in the journal, BMJ.

Meanwhile, the study found no association with adenovirus, which is also common in children.

 

Enterovirus: a group of viruses that cause infections leading to illness that is usually mild. About 90 percent of people have no symptoms or mild symptoms including fever, mild respiratory symptoms, flu-like fever and muscle aches, fever with a rash, and gastrointestinal symptoms. However, more severe diseases can sometimes develop, including brain and heart conditions, pneumonia and hepatitis.

Adenovirus: a group of viruses that cause infections in the respiratory and intestinal tracts. Respiratory infections include the common cold, conjunctivitis or pink eye, croup, bronchitis, or pneumonia. In the digestive tract they are more common in children younger than 5.

 

Viruses have been identified as a potential environmental factor that could cause those with the genetic pre-disposition for celiac disease to develop the condition. Once celiac disease is activated, the immune system responds to gluten as a trigger for intestinal damage and often gastrointestinal and other symptoms.

Previous research has linked celiac disease and the reovirus in children. One study has also explored the connection between the Epstein-Barr virus, which causes mono most often in teenagers and young adults, with celiac disease and other autoimmune conditions.  

Development of celiac disease could be a combination of ingesting a gluten-containing meal at the same time that you have an intestinal infection with the wrong kind of bacteria, Stephen Miller, Ph.D. director of the Interdepartmental Immunobiology Center at Northwestern University Feinberg School of Medicine and a Beyond Celiac Scientific Advisory Council member, said at the 2018 Beyond Celiac Research Symposium.

Connecting celiac disease and virus

In the recent study, 220 Norwegian children who had the genes related to celiac disease, HLA-DQ2 and DQ8, supplied stool samples from when they were 3-months to 3-years-old, which researchers analyzed to detect the viruses. They also tested blood samples for celiac disease antibodies every three months until the children were one-year-old and annually after that.

Ultimately, 25 children who averaged nearly 10 years of age, were diagnosed with celiac disease and matched with healthy controls for comparison. Enterovirus had been detected in 20 percent of stool samples provided by children who went on to develop celiac disease compared to 15 percent of controls.

When the virus was detected after gluten was introduced to the child’s diet it was associated with celiac disease, while virus detected before introduction was not, suggesting the infection triggered the disease, according to the study.  Similarly, infections that occurred in children after the end of breast feeding were associated with celiac disease, while those that occurred while children were being breast fed were not. Often, children infected with the virus had no or mild symptoms.

Larger sample

Researchers acknowledged that the relatively small number of children diagnosed with celiac disease is a study limitation, but said the results suggest that “infections with enterovirus in early life could be one of several key risk factors for development of [celiac] disease, with lifelong consequences.”

They called for more study in a larger sample size but noted that if enterovirus is confirmed as a trigger, vaccination could reduce the risk of celiac disease developing.

“Identification of specific viruses as triggers of celiac disease may have implications for preventive strategies,” the authors wrote.

In an editorial published by BMJ in response to the study, two researchers from the United Kingdom  who have studied pediatric celiac disease wrote that the association between enterovirus and later celiac disease  is “weak” and that it could not be inferred that the virus causes celiac disease. “Further work is needed to understand whether these findings are clinically meaningful,” they wrote.

You can read more about the study here and the editorial here.

 

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