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Celiac disease, a viral infection among possible causes, diagnosis by blood test

March 3, 2019

La

celiac disease

is an endemic social disease affecting approximately 1 percent

Of the population in Italy. Two recent studies indicate a’

infection

viral among possible causes and a new blood test method for the

diagnosis

on adults.

Celiac disease, the causes of an autoimmune disease

Celiac disease is a multi-organ autoimmune disease triggered by the ingestion of gluten in individuals predisposed by genetics and epigenetics. It affects about 200,000 individuals in Italy, with prevalence of diagnosis in the 19-40 (35% approx.) and 41-65 (31%) age groups. However, it is considered that to date about twice as many patients are still undiagnosed. There is also an estimated increasing occurrence in pediatric age, estimated to be around 1.3-1.5%.

The perinatal stages

(between the 29th week of gestation and the first 28 days after delivery) have been correlated with the risks of contracting the disease in childhood, in a study

conducted in Sweden among 1.9 million individuals. Where a probable role in altering the bacterial flora (dysbiosis) in the child has been attributed to various factors, including urinary tract infections and unfavorable socioeconomic conditions (impacting diet quality) of the mother.

Exposure to

glyphosate

through consumption of foods containing residues of it is in turn associated with the prevalence of celiac disease, in research conducted at MIT,

Massachusetts Institute of Technology

. (2) Where it has been shown how the pesticide – in addition to damaging intestinal villi and reducing the capacity of the microbiota to absorb vitamins and minerals-interfer with gliadin, one of the protein fractions of gluten. To the point of severely hindering its digestibility and stimulating the development of an immunological reaction.

Celiac disease, a viral infection among possible causes

The Norwegian study just published in the British Medical Journal, led by Christian Kahrs ofOstfold Hospital Trust, shows a significant correlation betweenenterovirus exposure early in life and the development of celiac disease. (3) Thus, among the many factors causing celiac disease, it seems that a viral infection can also be added.

The sample examined included 220 children with genetic predisposition to celiac disease. Twenty-five children-following enterovirus infection after the first year of age, with common symptoms such as colds, vomiting and foot-and-mouth disease-developed the disease. In contrast, no link was found between the onset of celiac disease and enterovirus infections in the first 12 months of life, nor with adenovirus infections.

In any case, breastfeeding confirms its protective efficacy of the child’s immune system, including with respect to the risk of developing autoimmune disease. Which is associated with enterovirus infections after weaning and subsequent introduction of gluten into the infant’s diet.

The enterovirus-celiachialink, according to the researchers, is explained by the virus’ ability to damage the intestinal mucosa. Resulting in qualitatively and quantitatively altered gluten absorption and subsequent development of gluten intolerance. Indeed, microorganisms are often identified in the literature as factors capable of triggering autoimmune diseases.

New celiac disease diagnosis by blood test alone, study finds

The development of diagnostic methods reliable and noninvasive is a priority goal for biomedical research and treatment effectiveness in the face of epidemiological data and estimates of the prevalence of undiagnosed diseases. Early diagnosis is indeed crucial, in order to ensure the patient receives the only treatment available today-a strictly gluten-free diet – in time against irreversible damage of the intestinal mucosa and the possible onset of even serious diseases.

Diagnosis of celiac disease in adults still requires blood sampling–for evaluation of celiac disease-specific antibodies (IgA anti-transglutaminase antibodies and anti-endomysium antibodies)–and esophago-gastro-duodenoscopy (EGDS), with biopsies to be taken at the level of the second portion of the duodenum.

In the child

meanwhile, a noninvasive test has been developed, based on the assay of antibody-sentinel in saliva

. This method, developed by the Pediatric Celiac Disease Center at Policlinico Umberto I of Sapienza University in Rome, has so far proven effective up to 9 years of age for children.

The scientific debate on whether biopsy should be performed in adults when antibodies test positive is still lively. (4) Also considered the difficulty of tracking disease progression, following administration of ‘gluten-free’ diet, by anti-transglutaminase and anti-endomysium antibody assay. And to distinguish with this tool alone those subjects with persistent intestinal damage versus those whose mucosa has been fully restored.

The US study published in Gastroenterology, by Rok Seon Choung et al. (Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota) introduces a new perspective on the diagnostic front. (5) A blood test could replace gastroduodenoscopy with duodenal villus biopsy in the future to ascertain celiac disease and record intestinal mucosal healing after the introduction of a gluten-free diet.

Indeed, examination of the tTG-DGP complex (synthesized peptides of deaminated gliadin and transglutaminase) demonstrates 99% sensitivity (1% false negatives) and 100% specificity (0% false positives) in distinguishing patients with celiac disease from healthy subjects. In contrast, the use of this test as a marker of intestinal mucosal healing during a ‘gluten-free‘ diet has a sensitivity of 84 percent and a specificity of 95 percent in assessing mucosal healing.

Thus, this study may direct research toward the use of a new biomarker useful for both diagnosis and monitoring of celiac patients. With the prospect, in selected subjects and children, that duodenal biopsy may be avoided. Promoting the spread of diagnostic tests and thus the health coverage of broader segments of the population. Even in countries and contexts where analyses have been limited for, among other reasons, health care cost control requirements.

Carlotta Suardi and Dario Dongo

Notes

(1) Namatovu F. et al. ‘Maternal and perinatal conditions and the risk of developing celiac disease during childhood‘. BMC Pediatr. 2016 Jun 8;16:77. doi: 10.1186/s12887-016-0613-y.

(2) Anthony Samsel and Stefanie Seneff, ‘

Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance.

‘. Interdiscip Toxicol. 2013 Dec; 6(4): 159-184. doi: 10.2478/intox-2013-0026. See also the free ebook ‘GMOs, the big scam‘, on https://www.greatitalianfoodtrade.it/libri/ogm-la-grande-truffa

(3) Christian R Kahrs et al, ‘

Enterovirus as trigger of coeliac disease: nested case-control study within prospective birth cohort’

. BMJ 2019; 364 doi:

https://doi.org/10.1136/bmj.l231

.

Kemppainen KM et al, ‘Factors That Increase Risk of Celiac Disease Autoimmunity After a Gastrointestinal Infection in Early Life‘. Clin Gastroenterol Hepatol 2017;15:694-702.e5. doi:10.1016/j.cgh.2016.10.033 pmid:27840181

A previous study associated the risk of developing celiac disease with reovirus T1L infection. See Romain Bouziat et al. ‘Reovirus infection triggers inflammatory responses to dietary antigens and development of celiac disease‘. Vol. 356, Issue 6333, pp. 44-50. doi: 10.1126/science.aah5298

(4) Norelle R. Reilly et al. (2018). ‘

Coeliac disease: to biopsy or not?

‘. Nature Reviews Gastroenterology & Hepatology; 15:60-66. https://doi.org/10.1038/nrgastro.2017.121

(5) Choung RS Rostamkolaei SK et al. ‘Synthetic Neoepitopes of the Transglutaminase-Deamidated Gliadin Complex as Biomarkers for Diagnosing and Monitoring Celiac Disease‘.
Gastroenterology.
2019 Feb;156(3):582-591.e1. doi: 10.1053/j.gastro.2018.10.025. Epub 2018 Oct 17.