A new blood test being developed by Walter and Eliza Hall Institute researchers can rapidly and accurately diagnose celiac disease without the need for prolonged gluten exposure.
Dr Jason Tye-Din, gastroenterologist and head of celiac research at the Walter and Eliza Hall Institute, said the new diagnostic test gave a result within 24 hours and preliminary findings indicated it could accurately detect celiac disease. It is hoped that larger studies will verify its role as a widely used tool for diagnosing celiac disease.
"Current diagnosis of celiac disease is limited by the need for intestinal biopsies and patients to be eating gluten," Dr Tye-Din said. "For the many people who follow gluten-free diets without a formal diagnosis, reliable testing for celiac disease requires them to consume gluten again, which is often unpleasant and difficult."
Researchers from the Melbourne institute, with colleagues from biotechnology company ImmusanT in Boston, US, led a study of the blood test in 48 participants, the results of which were published in the journal Clinical & Experimental Immunology.
"Our findings reveal this novel blood test is accurate after only three days of gluten consumption, not the several weeks or months traditionally required to make a diagnosis using intestinal biopsies," Dr Tye-Din said.
celiac disease is caused by an abnormal immune (T cell) reaction to gluten in the diet, leading to damage to the small intestine. It can cause digestive symptoms such as nausea, vomiting, bloating, and diarrhea, as well as lethargy, anemia, headaches and weight loss. As many as one in 60 women and one in 80 men in Australia have celiac disease, but four out of five remain undiagnosed.
Dr Tye-Din said that the blood test built on fundamental research discoveries the team had made about celiac disease. "This 'cytokine release' test measures the T cell response to gluten after three days of consumption, and a positive response is highly predictive of celiac disease," he said. "With this test, we were able to detect a T cell response in the majority of study participants known to have celiac disease and importantly, the test was negative in all of the patients who did not have celiac disease, even though they followed a gluten-free diet and thought gluten was the cause of their symptoms."
Dr Tye-Din said that many 'gluten sensitive' people found it distressing to reintroduce gluten into their diet in order to be tested properly for celiac disease. "People are fearful about experiencing unpleasant symptoms and end up stopping prematurely or avoiding testing altogether," he said.
"A test that simplifies diagnosis for patients is likely to significantly enhance disease detection. This new diagnostic approach is encouraging and we hope that larger studies can validate these findings and establish its role in the diagnosis of celiac disease, with the possibility of avoiding intestinal biopsies for diagnosis altogether."
Dr Bob Anderson, chief scientific officer at ImmusanT, said that the blood test could also assist in the monitoring of a therapeutic vaccine for celiac disease. "This is an important step toward a tool that could monitor changes in the small population of circulating T cells responsible for celiac disease when using treatments intended to restore tolerance to gluten, such as Nexvax2®, the compound currently being developed by ImmusanT," Dr Anderson said.
Dr Tye-Din said it was important for people following a gluten-free diet to be properly tested for celiac disease. "celiac disease can lead to significant long-term complications such as malnutrition, osteoporosis, infertility, pregnancy issues, liver failure, infection and cancer, so it is essential that people with this illness are diagnosed and treated to reduce these complications," he said.
- Noe Ontiveros, Jason A Tye-Din, Melinda Y Hardy, Robert P Anderson. Ex vivo whole blood secretion of interferon-γ (IFN-γ) and IFN-γ-inducible protein-10 (IP-10) measured by ELISA are as sensitive as IFN-γ ELISpot for the detection of gluten-reactive T cells in HLA-DQ2.5 associated celiac disease. Clinical & Experimental Immunology, 2013; DOI: 10.1111/cei.12232
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