After removing gluten from the diet, most patients with celiac disease recover and the intestinal mucosa regains its normal tissue architecture. Reintroduction of gluten (gluten challenge) of well-treated celiac patients is a valuable research tool to study the recall response to gluten. The magnitude and kinetics or the recall response, and the resulting intestinal damage, can however vary greatly between patients. Mass spectrometry based proteome analysis of archival intestinal biopsies from a previously published study of 19 well-treated patients before and after 14-day gluten challenge revealed that the patients who developed clear intestinal pathology by day 14 had signs of inflammation in the gut already at baseline. The protein differences resembled the changes later induced by gluten, suggesting that the gluten immune response was already ongoing but at very low level. In some of the patients, we also had data on the frequency of gluten-specific T-cells, and among these patients the frequency was higher in the patients that responded strongly to gluten. Read the study in full at Advanced Science, and the accompanying news feature.
We are currently investigating whether some patients that have been on a regular gluten free diet for a long time, may still have gluten specific T-cells that show signs of recently having encountered gluten. If so, this confirms that a regular gluten free diet may not be sufficient to fully curb the anti-gluten immunity in all celiac patients.