Scientists at the University of Maryland School of Medicine's Center for Celiac Research have proven that gluten sensitivity is different from celiac disease at the molecular level and in the response it elicits from the immune system. The research, published online in BMC Medicine, provides the first scientific evidence of a different mechanism leading to gluten sensitivity. It also demonstrates that gluten sensitivity and celiac disease are part of a spectrum of gluten-related disorders.
"We found differences in levels of intestinal permeability and expression of genes regulating the immune response in the gut mucosa," says lead investigator Alessio Fasano, MD, professor of pediatrics, medicine, and physiology at the School of Medicine and director of the Center for Celiac Research. The research documents the genes and the pathways - a sequence of reactions in the small intestine - possibly associated with gluten sensitivity. "Identifying and isolating specific 'biomarkers' in the immune response of people with gluten sensitivity could lead to diagnostic tools for the condition," says Fasano, who also directs the University of Maryland School of Medicine Mucosal Biology Research Center.
In people with celiac disease, gluten sets off an autoimmune reaction in the small intestine. The complex proteins found in wheat, rye, and barley trigger the immune system of a person with celiac disease to attack the person's small intestine. Left undiagnosed and untreated, celiac disease can lead to the development of other autoimmune disorders, as well as osteoporosis, infertility, neurological conditions, and, in rare cases, cancer.
Unlike celiac disease, gluten sensitivity is not associated with these serious conditions. Common symptoms of gluten sensitivity include abdominal pain similar to irritable bowel syndrome, fatigue, headaches, "foggy mind" or tingling of the extremities. There is also evidence that a subgroup of schizophrenic patients and autistic children might be affected by gluten sensitivity.
The Center for Celiac Research estimates that approximately 6 percent of the U.S. population, or 18 million people, suffers from gluten sensitivity. This group reacts with some of the same symptoms as people with celiac disease, but gluten-sensitive individuals typically test negative for celiac disease in diagnostic blood tests and show no signs of the damage to the small intestine that defines celiac disease.
"Imagine gluten ingestion on a spectrum," says Fasano. "At one end, you have people with celiac disease, who cannot tolerate one crumb of gluten in their diet. At the other end, you have the lucky people who can eat pizza, beer, pasta, and cookies - and have no ill effects whatsoever. In the middle, there is this murky area of gluten reactions, including gluten sensitivity. This is where we are looking for answers about how to best diagnose and treat this recently identified group of gluten-sensitive individuals," says Fasano.
"The Center for Celiac Research is leading the way in the effort to better understand the spectrum of gluten disorders," says E. Albert Reece, MD, PhD, MBA, vice president for medical affairs, University of Maryland, and John Z. and Akiko K. Bowers Distinguished Professor and dean, University of Maryland School of Medicine. "I have no doubt that further research will lead to new diagnostic tools and treatments for those who suffer from gluten sensitivity."
The latest research was conducted in collaboration with the Johns Hopkins School of Medicine, the Department of Experimental Medicine of the University of Naples in Italy, and the Institute of Food Sciences in Avellino, Italy. The BMC Medicine article is titled "Divergence of Gut Permeability and Mucosal Immune Gene Expression in Two Gluten-Associated Conditions: Celiac Disease and Gluten Sensitivity."
The University of Maryland School of Medicine's Center for Celiac Research has been at the forefront of education, research, diagnosis, and treatment for more than a decade. A groundbreaking 2003 study conducted by the Center for Celiac Research estimated that 1 in 133 people in the United States suffers from the disease. In 2000 the Center for Celiac Research developed a diagnostic blood test that is used to identify the disease. Founded in 1995, the Center for Celiac Research is an international leader in promoting the awareness of celiac disease to provide better care, better quality of life, and more adequate support for the celiac disease community worldwide.