Two dose gluten challenge in testing for celiac disease?

A study was done with 14 biopsy-proven celiac disease patients where they were given 3g or 10g of gluten. Blood tests were taken and endoscopy prior and post gluten exposure. A specific marker within the immune system called IL-2 was the earliest and most sensitive marker of acute gluten exposure. https://loom.ly/Kt-2xo0

With the push for new pharmaceuticals in celiac disease, researchers need to know if their drug works. What researchers don’t know is how much gluten exposure is required to induce changes in celiac blood tests or in the small intestine. None of us know, which is why we are all so afraid of any gluten exposure. But in clinical research, researchers need to know the minimum amount of exposure that causes a change.

Why the minimum amount? Typically research subjects have been on a gluten free diet for at least a year and in theory, are fully healed. When researchers are testing their drug, gluten exposure is required to know if there is a change in symptoms, blood tests, and damage to the small intestine in those taking the drug versus those that are on the drug. If the drug prevents symptoms and damage to the small intestine, they know the drug works against that level of gluten exposure.

For example, if you are fully healed and on a gluten free diet, during the clincial trial, you would theoretically not alter your gluten free habits. When testing to see if a drug prevented damage from gluten exposure, one would need to add gluten to the diet to know for sure whether the drug worked or not.

At the same time, doctors want to protect celiac patients from illness and long term damage. Do no harm and all.

This study starts a framework for a way to test for acute gluten exposure with a discreet, gluten exposure rather than small amounts of gluten over a long period. It also sets up a framework to test for celiac disease while on a gluten free diet.

I hope this short term gluten challenge with blood test is the future for celiac disease diagnostic testing and for use in clincial trials. What do you think?

#celiac #glutenfree #celiacdisease #coeliac #gluten #glutensensitive #il2