Associate Professor Jason Tye Din, WEHI
A one-off gluten challenge bookended by before and after measurements of circulating IL-2 levels might be the future for diagnosing or excluding coeliac disease.
According to international research published in Science Advances, IL-2 levels rise sharply within hours of a gluten challenge in people with coeliac disease.
The findings were made during phase 1 trials of an investigational antigen-specific immunotherapy for coeliac disease.
The cytokine response in 54 patients was observed as early as two hours after receiving an injection of the gluten peptides
Associate Professor Jason Tye-Din, head of coeliac research at the Walter and Eliza Hall Institute of Medical Research, told the limbic the cytokine response to gluten was specific to people with coeliac disease.
“What we’ve shown is when people with coeliac disease consume gluten, there is this IL-2 response. If they don’t have coeliac disease, that doesn’t happen. When you look at people without coeliac disease – healthy volunteers or people with gluten sensitivity – when they consume gluten there is no IL-2 response.”
He said they found a 15-fold elevation in IL-2 levels after an oral gluten challenge or a 270-fold elevation after an injection of gluten peptides.
“There may well have to be a threshold that needs to be established between defining who truly has coeliac disease and who doesn’t. This is probably the realm of future studies where you get larger number of people with true coeliac disease and those without, and then refine and validate the test and ensure the cut-off we select for the test truly differentiates these two groups of people.”
“The work is underway and we have a lot of good data now showing that it does seem to be very specific for coeliac disease and differentiates coeliac disease from gluten sensitivity.
“Developing a new diagnostic test is a process that can take years. So the key now is to continue these studies and to show that it is safe and accurate.”
“It may allow people to be diagnosed without having lots of gluten in their system but it may also allow people to avoid the need for an invasive biopsy of their bowel. That is another plus, particularly for children.”
Associate Professor Jason Tye-Din said there was a pressing need to identify those people on a gluten-free diet who did not need to be.
“A gluten-free diet can be unnecessarily restrictive and increase the risk of longer-term metabolic or heart-related complications because it is lower in whole grains.”
“There are strong social and medical reasons now to try and identity those people on a gluten-free diet who probably don’t need one and then direct their care, if they don’t have coeliac disease, to management of their symptoms elsewhere. That might involve some dietary approaches but allow them to have a much healthier diet.”
The study also involved coeliac disease experts from the US and Norway.