A new research breakthrough uncovering the very earliest inflammatory mechanism triggered in celiac sufferers after consuming gluten could lead to be novel blood test making it substantially easier for clinicians to diagnose the disease.
As anyone who has gone through the process can testify, our current methods for diagnosing celiac disease are not comfortable, or easy. There are several blood-based biomarkers that can indicate the disease, and these are often the first line of investigation for doctors, but many patients with symptoms of the disease switch to gluten-free diets before diagnosis, meaning these biomarkers will have inevitably declined to generally untraceable levels by the time of a blood test.
So, the initial stage of a celiac disease diagnosis involves a patient forcing gluten into their diet for several weeks, if not months, in order to trigger a detectable response allowing for a clear diagnosis. Needless to say, this can be an unpleasant experience for severe celiac sufferers, and it often results in the condition remaining undiagnosed for many years.
A new study, from an international team of researchers across Australia, Europe and the United States, has for the first time described a potential mechanism to explain the acute gastrointestinal symptoms that hit celiac patients in the immediate hour or two following gluten consumption.
It was discovered that a certain kind of protein called a cytokine can be found in increased levels in the bloodstream following exposure to gluten. This particular cytokine, called interleukin-2 (IL-2), is released by immune T cells, and the new research suggests it dramatically increases in volume in a celiac sufferer's bloodstream within two hours of exposure to gluten.
"The unpleasant symptoms associated with the disease are linked to an increase in inflammatory molecules in the bloodstream, such as interleukin-2 (IL-2), produced by T cells of the immune system," explains Bob Anderson, joint senior author on the study. "This response is similar to what happens when an infection is present, however for people with coeliac disease, gluten is the trigger."
As well as shedding light on the immunological mechanism that underpins the immediate digestive symptoms that appear in celiac patients following gluten consumption, the research also points to a novel blood test for diagnosing the disease. A blood test that may only require patients to consume a small single meal of gluten, as opposed to the longer stretches of consumption needed to detect prior blood-based biomarkers.
"For the many people following a gluten-free diet without a formal diagnosis of coeliac disease, all that might be required is a blood test before, and four hours after, a small meal of gluten," says Jason Tye-Din, one of the authors of the new study. "This would be a dramatic improvement on the current approach, which requires people to actively consume gluten for at least several weeks before undergoing an invasive procedure to sample the small intestine."
From a longer-term research perspective, this new study offers an insight into the acute pathophysiology driving celiac symptoms, hopefully directing scientists toward new strategies to disrupt these immediate negative responses to gluten. In the short term however, the study could dramatically alter the way this disease is diagnosed.
"It is clear this research has the potential to revolutionize the current testing regime for coeliac disease globally," says Michelle Laforest, CEO of Celiac Australia.
The new research was published in the journal Science Advances.
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