A three year study partly supported by charity Action Medical Research and Sainsbury’s has demonstrated the principle factor in wheat gluten that causes coeliac disease (CD). This peptide (small section of protein) causes tissue damage to the small intestine of CD patients. This research is published in the December edition of the journal Gut.
In the future the team at St Thomas’s Hospital in London hope to develop a modified form of wheat which retains the baking qualities of flour but is not toxic to individuals who are susceptible.
The peptide consists of 20 amino acids from the alpha-gliadins fraction of wheat gluten. The wheat peptide was given to 4 patients and then tissue from the intestine was examined for damage. The research showed that the peptide alone caused tissue damage and is therefore likely to be critical in the causation of coeliac disease.
Coeliac disease is a complete intolerance to gluten which is found in wheat flour, rye, barley and possibly oats. It causes inflammation and damage to the small intestine and symptoms can include abdominal pain, weight loss and various degrees of malnutrition. It can even cause death in children if left untreated. Before the understanding of gluten as the dietary factor in coeliac disease, in the early 1950’s, twenty percent of children died .
CD affects up to one in 100 people in England, Europe and the US. Some studies claim that coeliac disease can lead to serious long-term complications such as osteoporosis and bowel cancer if patients don’t avoid gluten in their diet. The condition is associated with thyroid disease, insulin dependent diabetes, liver disease and neurological problems like epilepsy.
CD has a strong genetic link and a further part of the study was to establish the true prevalence of coeliac disease in families. Blood samples were taken from 166 families* that had more than one person with coeliac disease. Blood was also taken from some people who were not blood relatives such as husbands or wives of the person with CD. Using antibody tests and a biopsy of the bowel, the prevalence of the condition was found to be five per cent among the first degree relatives of those with coeliac disease. This is much higher than the prevalence in the general population of 0.5 to one per cent. The team also used the family blood samples to study the possible genes involved in the development of coeliac disease. Part of this research was published in the Journal of Medical Genetics
The team also found that four per cent of people who have another auto-immune disorder, known as lupus** also had CD and this had not been reported before.
Simon Moore, Chief Executive of Action Medical Research said: “This is a really tremendous result. In the future, families that are affected may be able to be screened to see whether they have the condition which will be of great benefit to them. Remedial action can then be taken early on so that the terrible symptoms do not develop.”
Professor Paul Ciclitira, Professor of Gastroenterology at St Thomas’ Hospital in London who lead the research said: “Coeliac disease affects a very large number of people but it can be very difficult to diagnose. When the body sees gluten it has an allergic reaction and the top layer of the intestine is killed off, causing all the problems. The classical symptoms are diarrhoea and weight loss, but many people have much more subtle symptoms which may not be recognized as due to gluten intolerance. The disease may go undiagnosed, sometimes for years.
“In the UK there is no routine screening for family members, but these figures indicate that it should be considered. In many other European countries screening of relatives is automatic, and here I think it could lead to earlier diagnosis, saving the patient a lot of discomfort and the NHS money in treatments and repeated hospital and GP visits.”
“In the future we may be able to develop a way to work with the body’s own immune system to block the inflammation and stop the symptoms completely.
A genetic test for coeliac disease may be developed that could replace the more invasive biopsy of the small intestine, which doctors currently rely on.
The symptoms can be controlled by following a strict gluten-free diet. This means not just avoiding bread but cakes, biscuits, beer, malt flavourings, sweets, soups, baked beans and anything that is coated in flour or uses cereals as a binding agent.
Notes to editors
*(305 people and 914 first, second and third degree relatives)
** such as systemic lupus erythematosis (SLE). Damaged tissue causes progressive loss of function particularly in the kidneys, lungs and joints. A distinctive rash also appears on the face.
For more information please contact Louise Brown or Rob Orme in the Action Medical Research press office on 01403-327403 or 01403-327404.
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