A shorter gluten challenge may be possible

May 8, 2017

A shorter gluten challenge may be possible

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Celiac disease diagnosis would easier for those on the gluten-free diet before testing



By Amy Ratner, Medical and Science News Analyst

If you’ve gone on a gluten-free diet before being diagnosed with celiac disease, you have to go back to eating wheat, barley or rye for an extended period of time, and possibly suffer consequent symptoms, for tests for the condition to be accurate.

But the possibility that a very short, single gluten challenge would be enough to determine whether someone who is on the gluten-free diet has celiac disease was raised in research presented by ImmusanT today at Digestive Disease Week (DDW).

“Patients on a gluten-free diet who seek a diagnosis of celiac disease often refuse or cannot tolerate a gluten challenge of the duration usually needed for serological (blood) and histological (tissue) markers to become abnormal,” the ImmusanT study says, noting that it usually takes more than four weeks.

“A faster and more tolerable diagnostic is needed,” the Massachusetts biotechnology company focused on celiac disease said in a press release.

In the study, adult patients who were following the gluten-free diet were given either vital wheat gluten flour or a gluten-free flour drink in a double-blind, placebo controlled challenge. Blood samples were collected both before the challenge and at one to two hour intervals after. Additionally, adverse reactions were recorded for six days.

Twenty-one participants, 12 who were given gluten and nine who were given a placebo, completed the study. Four hours after the gluten challenge, serum and plasma levels in those who had been exposed to gluten were “significantly higher” than in those who had been given the placebo. Additionally, patient reported outcomes got worse for those who had been given gluten, though the study notes they were not sufficient to be statistically significant.

“In this study, we have identified a distinct cytokine signature present in the serum of subjects with celiac disease four hours after the ingestions of gluten, suggesting that the measurement of serum cytokines following a single gluten challenge may allow for the identification of patients on a gluten-free with celiac disease,” said Bob Anderson, M.D., ImmusanT chief scientific officer.

Cytokines

definitionCytokines are small secreted proteins released by cells that have a specific effect on the interactions and communications between cells. There are both pro-inflammatory and anti-inflammatory cytokines.

Leslie Williams, ImmusanT president and chief executive officer, said the study could lead to a more sensitive, rapid and tolerable alternative to current tests, though more research is needed. She noted that more than 80 percent of celiac disease cases remain undiagnosed.

At least some portion of undiagnosed cases is made up of those who have chosen to go on the gluten-free diet on their own to alleviate symptoms, sometimes after their doctor has refused to test them for celiac disease. Sometimes physicians suggest that patients just try the diet without celiac disease testing or after inconclusive test results. In both cases, it’s difficult to get an accurate diagnosis because patients do not want to get sick again.

They also sometimes don’t see how the diagnosis will make a difference in their lives since the gluten-free diet is currently the only treatment for celiac disease. However, a definitive diagnosis can lead to better adherence to the gluten-free diet and better monitoring for development of other autoimmune disorders related to celiac disease.

You can read more about ImmusanT and Nexvax2®, a therapeutic vaccine for celiac disease, here.

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