Researchers pinpoint how and where gluten response begins in celiac disease

A team of international researchers have determined where in the digestive system the inflammatory response to gluten begins in people with celiac disease. It was previously believed that it occurred within the gut wall and involved only immune cells. Now, the new findings suggest that intestinal epithelial cells play a main role in activating the inflammatory response to gluten.The researchers, including a team at McMaster University in Hamilton, Ont., used cell- and tissue-based studies to study the immune response to gluten. They found that gluten antigens are present on intestinal epithelial cells and activate gluten-specific CD4+ T cells. Microbial elastase pre-digests the gluten, which enhances the activation of the T cells.While the mechanism had been suggested previously, the researchers developed an in vitro model of the intestinal lining, which allowed them to observe the process under controlled conditions.“This allowed us to narrow down the specific cause and effect and prove exactly whether and how the reaction takes place,” said Tohid Didar in a press release. Didar is a corresponding author on the paper and an associate professor at McMaster University’s school of biomedical engineering. He holds the Canada Research Chair in nano-biomaterials.Drug therapy that targets the intestinal endothelial cells could alter the immune response in patients with celiac disease, the authors concluded. This includes using medications already in clinical trials, said Dr. Elena Verdu, a corresponding author on the paper who is a professor of gastroenterology and director of McMaster’s Farncombe Family Digestive Health Research Institute.“The only way we can treat celiac disease today is by fully eliminating gluten from the diet. This is difficult to do, and experts agree that a gluten-free diet is insufficient,” Dr. Verdu noted.The research was published in Gastroenterology.Read: Canadian gastroenterologists weigh in on new celiac disease guidelines

Researchers pinpoint how and where gluten response begins in celiac disease

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