Sunday, July 29, 2007
Brain and nerve cell death in celiac disease from eating wheat gluten
How Celiac disease and gluten ingestion results in neurological injury is not well understood. It is however now well recognized that celiac disease and gluten are related to a variety of brain and peripheral nerve problems. According to a new study, nerve cell death, known in medicine by the term apoptosis, occurs in celiac disease not just from the presence antibodies against nerve cells in the blood of people with celiac disease with neurologic problems but from other factors in the blood, especially gliadin and tissue transglutaminase antibodies, and in people without obvious neurological problems. The presence of antibodies to gliadin and tissue transglutaminase in the blood are associated with nerve cell death in the absence of anti-nerve antibodies.
The complicated nature of the process that gluten ingestion and celiac disease results in neurological damage can be appreciated by the reading the study by Cervio et al. from the University of Bologna, Italy, published in the July 2007 issue of Gastroenterology. Their very detailed and difficult to understand article describes the very elegant yet extremely sophisticated study they performed. The study they conducted attempted to determine if it is the anti-nerve antibody, known as antineuronal antibody, that causes the degenerative damage to the brain and nerves seen commonly in celiac disease. They tested whether the blood of people with neurological disease with and without celiac disease and with and without antibodies to nerve cells could cause nerve cell death in cells studied outside the body. They compared the effects of blood from people with celiac disease with these antibodies but without neurological symptoms, people with celiac disease without antibodies and without neurological symptoms, and people with neurological disease but not celiac disease.
They did find that the blood from those people with celiac disease with neurological symptoms that had antineuronal antibodies caused the greatest nerve cell death but interestingly they found that blood from people without the antibodies including people with celiac disease without neurological could cause substantial nerve cell death. They conclude that the blood of people with celiac disease without these anti-nerve cell antibodies “may bear a neurotoxic potential”. They go on to state that this “may be ascribed to several factors such as the wide array of other autoantibodies contained in the sera, namely the combination of both antigliadin and anti-tTG antibodies.” Within the article mention is made of the effect on both central nervous system (brain) and enteric nervous system (gut).
I find the possibilities quite intriguing and curious in that there is accumulating evidence that irritable bowel syndrome is a disorder of the enteric nervous system, possibly related to altered gut permeability (leaky gut) associated with altered gut flora (bad bacteria and yeast). In addition this effect in some patients may be related to increase mast cells (mastocytic enterocolitis) resulting from some stimulus such as stress or gut infection. Furthermore, a recent study indicates that gluten free diet is effective in many people with diarrhea predominant IBS when they have elevated gliadin antibodies in the blood especially if they are positive for the high risk celiac disease white blood cell protein pattern HLA DQ2. However, as in much of medicine, the ability to connect these dots is limited by a research process that is quite cumbersome, highly political, pharmacy industry funded, and carried out by scientists focused on their particular area of interest, experience and funding. We will explore the gluten-IBS link in the next post. Stay tuned as we continue our journey.
Cervio E. et al. Sera of patients with celiac disease and neurological disorders evokes a mitochondrial-dependent apoptosis in vitro. Gastroenterology July 2007; 133: 195-206.
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