Study May Explain Cause of Non-Celiac Wheat Sensitivity

New research offers a potential explanation for why individuals without celiac disease or wheat allergy still experience gastrointestinal and extraintestinal symptoms after ingesting wheat.

A team led by researchers at Columbia University Medical Center sought to determine if sensitivity to wheat in the absence of celiac disease is connected to systemic immune activation that may be linked to enteropathy. In an effort to accomplish this goal, the investigators conducted a study of 80 individuals with non-celiac gluten or wheat sensitivity (NCWS), 40 individuals with celiac disease, and 40 healthy controls. Sera were analyzed for markers of intestinal cell damage and systemic immune response to microbial components.
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The authors found that participants with wheat sensitivity had significantly increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, as well as antibody reactivity to bacterial LPS and flagellin. In addition, circulating levels of fatty acid-binding protein 2 (FABP2), a marker of intestinal epithelial cell damage, were significantly elevated in the affected individuals and correlated with the immune responses to microbial products, according to the researchers. The investigators also noted a significant change toward normalization of the levels of FABP2 and immune activation markers in a subgroup of individuals with wheat sensitivity who adhered to a diet excluding wheat and related cereals.

While the NCWS group did not possess the intestinal cytotoxic T cells seen in celiac patients, participants in this group did have a marker of intestinal cellular damage that correlated with serologic markers of acute systemic immune activation, according to the authors.

These results indicate that there are "objective biological changes in a significant number of individuals who report sensitivity to wheat without having celiac disease, including markers of intestinal cell damage and systemic immune activation," said Armin Alaedini, PhD, an assistant professor in the department of medicine and Institute of Human Nutrition at Columbia University Medical Center, and coauthor of the study.

The findings "should help with the recognition that there may be a biological basis for the symptoms experienced by patients who complain of wheat sensitivity, even in the absence of celiac disease and wheat allergy," said Dr Alaedini, adding that the only current way for diagnosis of non-celiac wheat sensitivity is through thorough clinical examination that would involve food restriction and food challenge.

"As our work shows that there are clear biological changes in the affected patients that are associated with certain biomarkers, a blood test may become available in the future for accurately diagnosing patients," he said.

—Mark McGraw

Reference

Uhde M, Ajamian M, Caio G, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease [published online July 25, 2016]. Gut. doi:10.1136/gutjnl-2016-311964.