title: Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease.
abstract: BACKGROUND
  Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient.We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration.
  
  
  METHODS
  Twenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined.
  
  
  RESULTS
  Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients.
  
  
  CONCLUSIONS
  Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.
authors: Paediatric Research Centre and School of Medicine, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Marja-Leena
authors: ML
authors: Lähdeaho
authors: Markku
authors: M
authors: Mäki
authors: Kaija
authors: K
authors: Laurila
authors: Heini
authors: H
authors: Huhtala
authors: Katri
authors: K
authors: Kaukinen
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D000917:Antibody Formation; D001323:Autoantibodies / Q000032:analysis; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications / Q000276:immunology / Q000473:pathology*; D015331:Cohort Studies; D004751:Enteritis / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology*; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D000906:Antibodies; D001323:Autoantibodies; D007070:Immunoglobulin A; D005983:Glutens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins