Joseph Gustaitis

A common intestinal virus contracted in early childhood appears to initiate the later development of celiac disease, according to a new report from Norway published in the British Medical Journal.

Because previous research had suggested that infections in the stomach or intestines might play a role in celiac disease, the researchers decided to investigate two common viruses—enterovirus, which is a usually mild virus of the digestive tract, and adenovirus, which typically causes cold-like symptoms but can also affect the bladder, stomach, and intestines. They began with 220 very young children (ages 3 months to 36 months) who showed a genetic makeup characteristic of most patients with celiac disease and then collected stool samples to see if the children had either of the two viruses. After that, the researchers conducted regular blood tests for celiac disease antibodies—first at 3, 6, 9, and 12 months and then every year for 10 years.

After 10 years, 25 of the 220 original children were diagnosed with celiac disease. The researchers found that enterovirus was significantly more frequent in the samples collected from these children. In other words, there was a significant relationship between exposure to enterovirus and later risk of developing celiac disease. No such relationship, however, was found between adenovirus and celiac disease.

The researchers cautioned that the number of children who eventually got celiac disease was limited, and they also said it was possible that unknown factors they didn’t measure could have played a role. Nevertheless, if further research corroborates their findings, identifying viruses as triggers in celiac disease might lead to prevention. As they put it, “If enterovirus is confirmed as a trigger factor, vaccination could reduce the risk of development of celiac disease.”

Wouldn’t it be great if there were such as thing as wheat that was safe for people with celiac disease? Then they would be able to eat products containing wheat, which they are now advised to stay away from.

Such a wheat might be possible, according to a new report from Germany. The key is what is known as CRISPR technology, which has been getting increasing attention in the news. CRISPR, which stands for Clustered Regularly Interspaced Short Palindromic Repeats, is a technique used in genome engineering whereby it’s possible to edit genes by cutting DNA at precise locations. The idea of using CRISPR in wheat comes from the work of Aurélie Jouanin, Ph.D., a research scientist at  KWS group in Einbeck, Germany, a firm that specialized in developing high-performance seeds for farmers.

It’s already possible to develop a gluten-free wheat with all the gluten genes removed, but the wheat thus produced would not be suitable for baking. Jouanin’s recently published Ph.D. thesis explains how to use CRISPR technology to target and modify certain genes with precision and to then determine which genes have been modified and which remain to be edited.

The wheat would not be entirely free of gluten, but the gluten would have been modified in such a way that it would not contain what are known as immunogenic epitopes, which are parts of molecules that provoke an immune response.

The technology is complex and has yet to be refined, but Jouanin points out that some recently developed CRISPR techniques have illuminated a path toward its fulfillment. She adds that when such a wheat is developed it will need to be tested on humans to confirm that it does not provoke an immune response. The wheat might not be gluten-free exactly, but for people with celiac disease it would be just as welcome.

An intestinal biopsy has long been the standard method for determining with certainty that a person has celiac disease. A new report from Finland, however, now says there is a blood test can accurately diagnose celiac disease in some patients without the need for a biopsy.

The patients who qualify for the blood test, the researchers say, are those who fit a “triple criteria.” These criteria involve the presence of certain antibodies and whether the patients have the celiac genotype (genetic mutations associated with celiac disease).

To test their theory, the research team, which was headed by Kalle Kurppa, M.D., of the University of Tampere in Finland, recruited three groups. The first was considered at high risk for celiac disease, the second was moderate risk, and the third was low risk. Of these, 90 subjects fit the “triple criteria” and were given a specially designed blood test. Of these 90, the ones who tested positive for celiac disease according to the blood test were then given intestinal biopsies.

The biopsies showed that every one of them did in fact have celiac disease, which gave the blood test a predictive value of 100 percent. The researchers also noted that the test worked well even on people who had no symptoms of celiac disease, which was advantageous because it can be hard to recognize the symptoms.

The researchers summed up their findings by saying that the use of their blood test could “lead to substantially reduced number of endoscopies and subsequent healthcare savings without affecting the diagnostic accuracy.”

According to new research from Germany, a food additive commonly used in cheese, bread, hot dogs, pasta and other processed foods might both cause and trigger the autoimmune attacks that are characteristic of celiac disease.

For some time, researchers have been exploring the possibility that environmental factors—such as infections, drugs, surgery, and so on—might lie behind celiac disease. More recently, they have been looking into the possible role of food additives and this most recent research from Germany has identified a suspect called microbial transglutaminase.

Transglutaminase is naturally produced in the body, but it has a different structure from the microbial variety used in food products. And, according to Aaron Lerner, M.D., of the AESKU.KIPP Institute in Wendelsheim, Germany,  these food products could “significantly increase” the amount of transglutaminase in the gut. And it’s known that gluten allows certain proteins, including microbial transglutaminase, to interact with immune cells in the gut.

To test their theory, the scientists tested antibodies from the blood of celiac patients. They discovered that microbial transglutaminase, when bound to gluten fragments, is likely a target of the immune response in celiac disease.

Does this mean that microbial transglutaminase is unsafe? At this stage the researchers can’t draw a definitive conclusion. According to Dr. Lerner, “Ultimately all we have so far are associations between microbial transglutaminase and celiac disease.” What needs to be done, he says, is “experimenting with exposure in animal models, intestinal cell lines, or biopsies.” In the meantime, he recommends “transparency and vigilance with regards to labeling of foods processed using microbial transglutaminase.”