For many people, celiac disease is a mysterious disorder that doesn't allow people to eat foods that contain wheat or other products that contain gluten. Now scientists have actually seen how gluten interacts with cells in the immune system, which gives them a window into celiac disease secrets and hopefully new ways to manage the condition.

Celiac disease is a common disorder

The Celiac Disease Foundation reports that 1 in every 133 people in the United States has celiac disease. In fact, about 50 percent of the general population has the specific human leukocyte antigens (HLA-DQ2 or HLA-DQ8) scientists consider necessary for the development of celiac disease.

Having these immune response genes, however, does not mean individuals will necessarily develop celiac disease. About 5 percent of people with HLA-DQ2 and less than 1 percent of those with HLA-DQ8 develop the disease.

Briefly, celiac disease is a chronic, inherited autoimmune disease that can affect people of any age. People who have celiac disease experience an immune system reaction when they consume foods that contain gluten, a type of protein found in some grains, including all types of wheat (e.g., durum, einkorn, faro, kamut, semolina, spelt), as well as barley, rye, and triticale.

The immune reaction that affects people with celiac disease has an impact on the intestinal tract as well as causes symptoms that affect lifestyle, such as abdominal pain, bloating, constipation, diarrhea, fatigue, gas, weakness, and weight loss, among others. Prebiotics and probiotics can help relieve some of these symptoms.

This latest study is the first time researchers have been able to observe how gluten and certain immune system cells called T-cells interact, which provides information on how celiac disease is triggered. In people with celiac disease, T-cells are prompted to attack the "bad" proteins, which in turn can cause damage to the small intestine and thus interfere with the ability of the intestinal tract to absorb essential nutrients.


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Investigators from Monash University and a biotechnology company called ImmusanT Inc participated in the study. According to Dr. Hugh Reid, a senior research fellow at Monash University, the discovery "is the first time that the intricacies of the interaction between gluten and two proteins that initiate immune responses have been visualized at a sub-molecular level."

The finding will hopefully help advance development of a blood test and a vaccine (Nexvax2®) for individuals with HLA-DQ2, both of which are being pursued by ImmusanT. Currently there is no cure for celiac disease, and the only way to treat it effectively is for patients to eliminate gluten from their diet.

Celiac disease is a challenge

Living gluten free in a wheat world is a challenge, given the ubiquitous and often hidden presence of this protein in a vast array of foods. In addition to foods clearly identified as containing wheat, rye, and other gluten items, the proteins may also be hidden in ingredients such as malt, natural flavors, colorings, soy sauce, cocoa, vegetable protein, and seasonings, as well as in fillers, binders, excipients, and extenders.

In addition to meeting the challenge of avoiding gluten, individuals with celiac disease are also at an increased risk of associated conditions. Some of those disorders include dermatitis herpetiformis (characterized by intensely itchy skin), type 1 diabetes, liver diseases, rheumatoid arthritis, scleroderma, Raynaud's syndrome, Sjogren's syndrome, and lupus, among others.

The new study has opened a window to a greater understanding of celiac disease, but much work remains to be done to reveal further secrets of this daunting disorder.

SOURCES:

Broughton SE et al. Biased T cell receptor usage directed against human leukocyte antigen DQ8-restricted gliadin peptides is assocaited with celiac disease. Immunity 2012 October 11. doi:10.1016/j.immuni.2012.07.013

Celiac Disease Foundation

Monash University

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