Spontaneous Latency in Adult Patients with Celiac Disease on a Normal Diet after Gluten-Free Diet: Case Series
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Celiac disease (CeD) is an immune condition induced by the consumption of gluten-containing foods in genetically-predisposed persons. CeD, in addition to digestive disease, is a multisystem disorder. If untreated, it is potentially can be a dangerous disorder and lead to morbidity and even mortality. At present, the only treatment option is a lifelong gluten-free diet (GFD), and all authors recommended this regimen. To the best of our knowledge, there are rare reports of the complete remission of disorder on GFD and reintroduction of a normal diet in affected patients. In this report, we describe five patients with CeD who developed complete remission of clinical symptoms, histopathological changes, and serology on a gluten-containing diet. All patients had CeD based on a positive tissue transglutaminase antibody (TTG IgA) and typical histopathological changes in duodenal biopsy with the complete disappearance of symptoms on the GFD regimen. All patients followed GFD for a mean 4 (±0.54) years. In conclusion, this study has shown that some CeD patients diagnosed in adulthood can recover a normal mucosa after a long period of the gluten-containing diet without relapsing any clinical or biological symptoms of CeD.Keywords:
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Celiac disease (CD) is an intestinal malabsorption characterized by intolerance to cereal proteins accompanied by immunological responses to dietary gliadins and tissue transglutaminase, an autoantigen located in the endomysium. Tissue transglutaminase belongs to the family of enzymes that catalyze protein cross-linking reactions and is constitutively expressed in many tissues as well as being activated during apoptosis. The role of gliadins in eliciting the immune response in CD and how transglutaminase is linked to the primary reaction are still unclear. In this work, we report the production and analysis of six phage Ab libraries from the peripheral and intestinal lymphocytes of three CD patients. We were able to isolate Abs to transglutaminase from all intestinal lymphocytes libraries but not from those obtained from peripheral lymphocytes. This is in contrast to Abs against gliadin, which could be obtained from all libraries, indicating that the humoral response against transglutaminase occurs at the local level, whereas that against gliadin occurs both peripherally and centrally. Abs from all three patients recognized the same transglutaminase epitopes with a bias toward the use of the V(H)5 Ab variable region family. The possible role of these anti-transglutaminase Abs in the onset of CD and associated autoimmune pathologies is discussed.
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Avoiding exposure to gluten is currently the only effective treatment for celiac disease. However, the evidence suggests that for most affected individuals, exposure to less than 10 mg/day is unlikely to cause histological changes to the intestinal mucosa. The daily diet of people with celiac disease does not rely solely on gluten-free pre-packaged foods, but also on naturally gluten-free grains (e.g., rice, buckwheat, ...) and foods with grain-derived ingredients (i.e., flour and starches) used for cooking and baking at home. The objective of this study was to estimate the level of incidental gluten potentially present in gluten-free diets from a Canadian perspective. We have conducted gluten exposure estimations from grain-containing foods and foods with grain-derived ingredients, taking into consideration the various rates of food consumption by different sex and age groups. These estimates have concluded that if gluten was present at levels not exceeding 20 ppm, exposure to gluten would remain below 10 mg per day for all age groups studied. However, in reality the level of gluten found in naturally gluten-free ingredients is not static and there may be some concerns related to the flours made from naturally gluten-free cereal grains. It was found that those containing a higher level of fiber and that are frequently used to prepare daily foods by individuals with celiac disease could be a concern. For this category of products, only the flours and starches labelled "gluten-free" should be used for home-made preparations.
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This chapter contains sections titled: Physiological Functions of Transglutaminases Transglutaminase and the Formation of the Cross-Linked Envelope of Terminally Differentiated Keratinocytes Substrates of Keratinocyte Transglutaminase Proteins With Abnormally Long Polyglutamine As Substrates of Neuronal Transglutaminases in Genetic Diseases of the Central Nervous System Transglutaminase in Alzheimer's Disease Transglutaminase in Parkinson's Disease What Makes a Good Transglutaminase Substrate? Features Shared by Transglutaminase Substrates and Proteins Associated With Diseases of Polyglutamine Expansion Perspectives Acknowledgements References
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Abstract Background In recent decades, the celiac disease showed a gradual increase in prevalence. Therefore, there was a raised demand of gluten-free products. EU Reg. 1169/2011 states that 20 mg.kg-1 (ppm) is the maximum gluten content in food for celiac people, and that “gluten-free” labelling must be put on compliant food packages. This work is a study on different food categories, aiming at verifying the safety of analyzed samples. Methods Totally, 4615 gluten-free-labelled specimens were collected from January 2019 to April 2022 (pasta, 2944; cured meat, 566; flours/bakery, 489; sweets, 125 and other matrices, 491). A commercially available E.L.I.S.A. kit, according to the AOAC 2012.01-2016 method, was used to quantify gluten. Results In 97% of samples (4475) the gluten content was <5 ppm (lower LOD), and in 2.4% (112) it was between 5 ppm and <20 ppm. In the remaining 0.6% (28), the gluten concentration was ≥20 ppm. Of these, 0.32% (15) were between 20 and <80 ppm (upper LOD), and 0.28% (13) ≥80 ppm. Conclusions The increased prevalence of celiac disease and the consumers’ perception that a gluten-free diet gives benefits, lead to a greater demand of gluten-free products. In this study, 99.4% of samples were compliant with the gluten-free labelling and safe for celiac consumers. The 0.32% had a gluten content between 20 and 80 ppm, still considered “compliant”, according to the EU Reg. 828/2014 that defines as very low gluten containing (thus edible for some celiac groups), those products with a gluten content <100 ppm. Only 0.28% of samples was non-compliant (≥80 ppm). However, the authors accounted irregular those foods with ≥20 ppm. Considering the importance of these products in the daily diet, and the increasing probability to get sick by individuals, the study of their compliance to the law limits results to be important. Key messages • A continuous surveillance of gluten-free-labelled food products is very important to prevent risks for celiac consumers. • The foodstuffs distributed in the two considered regions are mainly safe for celiac patients.
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A strict and lifelong gluten-free diet is the only treatment of celiac disease. Gluten contamination has been frequently reported in nominally gluten-free products. The aim of this study was to test the level of gluten contamination in gluten-free products currently available in the Italian market.A total of 200 commercially available gluten-free products (including both naturally and certified gluten-free products) were randomly collected from different Italian supermarkets. The gluten content was determined by the R5 ELISA Kit approved by EU regulations.Gluten level was lower than 10 part per million (ppm) in 173 products (86.5%), between 10 and 20 ppm in 9 (4.5%), and higher than 20 ppm in 18 (9%), respectively. In contaminated foodstuff (gluten > 20 ppm) the amount of gluten was almost exclusively in the range of a very low gluten content. Contaminated products most commonly belonged to oats-, buckwheat-, and lentils-based items. Certified and higher cost gluten-free products were less commonly contaminated by gluten.Gluten contamination in either naturally or labeled gluten-free products marketed in Italy is nowadays uncommon and usually mild on a quantitative basis. A program of systematic sampling of gluten-free food is needed to promptly disclose at-risk products.
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