(04-03-12) Monitoring of gluten-free diet compliance in celiac patients by assessment of gliadin 33-mer equivalent epitopes in feces

1,2,3
1. Isabel Comino,
2. Ana Real,
3. Santiago Vivas,
4. Miguel ?ngel S?glez,
5. Alberto Caminero,
6. Esther Nistal,
7. Javier Casqueiro,
8. Alfonso Rodr?guez-Herrera,
9. ?ngel Cebolla, and
10. Carolina Sousa
+Author Affiliations
1. 1From the Departamento de Microbiolog?a y Parasitolog?a, Facultad de Farmacia, Universidad de Sevilla, Seville, Spain (IC, AR, and CS); the Servicio de Aparato Digestivo, Hospital Universitario de Le?n, Leon, Spain (SV); Biomedal SL, Seville, Spain (M?S and ?C); the ?rea de Microbiolog?a, Facultad de Biolog?a y Ciencias Ambientales, Universidad de Le?n, Leon, Spain (AC, EN, and JC); and the Unidad de Gastroenterolog?a y Nutrici?n, Instituto Hispalense de Pediatr?a, Seville, Spain (AR-H).
+Author Notes
? ↵2 Supported by a grant (IPT-010000-2010-026, subprograma INNPACTO) from the Ministerio de Ciencia e Innovaci?n (Fondos Tecnol?gicos 2007-2013, Fondo Europeo de Desarrollo Regional), the Corporaci?n Tecnol?gica de Andaluc?a and Agencia de Innovaci?n y Desarrollo de Andaluc?a (cofounder of the study; to ?C), a Becas del Programa de Formaci?n del Profesorado Universitario fellowship from the Ministerio de Educaci?n (to IC), a fellowship from Junta de Andaluc?a (Proyectos de Investigaci?n de Excelencia, AGR-4783; to AR), a grant from the Obra Social Caja Burgos, and a grant from the Junta de Castilla y Le?n, Consejer?a de Sanidad (reference 318/A/08; to SV and JC).
? ↵3 Address correspondence to C Sousa, Departamento de Microbiolog?a y Parasitolog?a, Facultad de Farmacia, Universidad de Sevilla, c/ Profesor Garc?a Gonz?lez no. 2, 41012 Seville, Spain. E-mail: [email protected].
Abstract
Background: Certain immunotoxic peptides from gluten are resistant to gastrointestinal digestion and can interact with celiac-patient factors to trigger an immunologic response. A gluten-free diet (GFD) is the only effective treatment for celiac disease (CD), and its compliance should be monitored to avoid cumulative damage. However, practical methods to monitor diet compliance and to detect the origin of an outbreak of celiac clinical symptoms are not available.
Objective: We assessed the capacity to determine the gluten ingestion and monitor GFD compliance in celiac patients by the detection of gluten and gliadin 33-mer equivalent peptidic epitopes (33EPs) in human feces.
Design: Fecal samples were obtained from healthy subjects, celiac patients, and subjects with other intestinal pathologies with different diet conditions. Gluten and 33EPs were analyzed by using immunochromatography and competitive ELISA with a highly sensitive antigliadin 33-mer monoclonal antibody.
Results: The resistance of a significant part of 33EPs to gastrointestinal digestion was shown in vitro and in vivo. We were able to detect gluten peptides in feces of healthy individuals after consumption of a normal gluten-containing diet, after consumption of a GFD combined with controlled ingestion of a fixed amount of gluten, and after ingestion of <100 mg gluten/d. These methods also allowed us to detect GFD infringement in CD patients.
Conclusions: Gluten-derived peptides could be sensitively detected in human feces in positive correlation with the amount of gluten intake. These techniques may serve to show GFD compliance or infringement and be used in clinical research in strategies to eliminate gluten immunotoxic peptides during digestion. This trial was registered atclinicaltrials.gov as NCT01478867.

Source: Am J Clin Nutr March 2012 vol. 95 no. 3 670-677

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