Plain language summary
A gluten-free diet is currently the only reliable therapeutic approach for coeliac disease (CD), an immune-mediated condition where eating gluten causes intestinal inflammation. Hydrolysing wheat flour with a sourdough enriched with lactobacilli and fungal proteases has been shown to be effective in reducing the gluten in the bread baked with it to less that 10ppm (which should be safe for CD patients). This randomised prospective study was designed to confirm the lack of an immunological response to the hydrolysed gluten in CD patients, both in vitro and in vivo. 20 CD patients who were in clinical remission and had followed a gluten-free diet (GFD) for at least three years were enrolled into this study and randomised to receive either natural wheat (10g gluten per day) or hydrolysed wheat (10g hydrolysed gluten per day) for three days. In vitro studies using intestinal cells from three of the study participants showed that the hydrolysed gluten did not elicit an immune response, whilst the natural gluten did. In vivo, there were no statistically significant increases in immune reactivity in the hydrolysed gluten patients, and no-one in this group experienced any symptoms. In the natural wheat group significant increases in immune reactivity to gluten were seen although only one person experienced symptoms (abdominal pain). The authors conclude that wheat flour hydrolysed with an enriched sourdough may be an alternative for the CD patient’s diet.
Abstract
BACKGROUND A gluten-free diet is currently the only reliable therapeutic strategy that is approved for coeliac disease (CD). For many patients, however, compliance remains inadequate. AIM: To investigate the immunogenicity of wheat flour that was pre-treated with selected lactobacilli and fungal proteases (hydrolysed wheat gluten) in coeliac patients. METHODS The immunogenicity of hydrolysed wheat gluten was evaluated both in vitro in intestinal T cell lines (TCLs) and in vivo in treated CD patients after a short-term gluten challenge. Twenty treated CD patients were enrolled and equally randomised into two groups. The patients ate bread that was prepared with hydrolysed wheat flour or natural wheat flour (10 g of gluten/d for 3 days). The interferon (INF)-γ responses to natural gliadin and a 33-mer peptide were assessed by the enzyme-linked immunospot (ELISPOT) assay on peripheral blood mononuclear cells (PBMCs) both before and 6 days after the start of the challenge. RESULTS Hydrolysed wheat was not able to activate the TCLs from the coeliac intestinal mucosa. Consistent with the in vitro results, no significant increase in INF-γ secretion was observed in patients who consumed hydrolysed wheat flour. Conversely, the consumption of natural wheat gluten mobilised INF-γ secreting cells in the blood (P<.05). CONCLUSIONS We confirm that fermentation of wheat flour with sourdough lactobacilli and fungal proteases is capable of abolishing the T cell immunogenicity of gluten in coeliac patients. Our data also validate the short-term oral challenge as a useful tool for testing the efficacy of novel therapeutic approaches.
Methodological quality
Jadad score
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2
Allocation concealment
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Not applicable
