title: Salivary Gluten Degradation and Oral Microbial Profiles in Healthy Individuals and Celiac Disease Patients.
abstract: Celiac disease (CD) is a chronic immune-mediated enteropathy induced by dietary gluten in genetically predisposed individuals. Saliva harbors the second highest bacterial load of the gastrointestinal (GI) tract after the colon. We hypothesized that enzymes produced by oral bacteria may be involved in gluten processing in the intestine and susceptibility to celiac disease. The aim of this study was to investigate salivary enzymatic activities and oral microbial profiles in healthy subjects versus patients with classical and refractory CD. Stimulated whole saliva was collected from patients with CD in remission (n= 21) and refractory CD (RCD;n= 8) and was compared to healthy controls (HC;n= 20) and subjects with functional GI complaints (n= 12). Salivary gluten-degrading activities were monitored with the tripeptide substrate Z-Tyr-Pro-Gln-pNA and the α-gliadin-derived immunogenic 33-mer peptide. The oral microbiome was profiled by 16S rRNA-based MiSeq analysis. Salivary glutenase activities were higher in CD patients compared to controls, both before and after normalization for protein concentration or bacterial load. The oral microbiomes of CD and RCD patients showed significant differences from that of healthy subjects, e.g., higher salivary levels of lactobacilli (P< 0.05), which may partly explain the observed higher gluten-degrading activities. While the pathophysiological link between the oral and gut microbiomes in CD needs further exploration, the presented data suggest that oral microbe-derived enzyme activities are elevated in subjects with CD, which may impact gluten processing and the presentation of immunogenic gluten epitopes to the immune system in the small intestine.IMPORTANCEIngested gluten proteins are the triggers of intestinal inflammation in celiac disease (CD). Certain immunogenic gluten domains are resistant to intestinal proteases but can be hydrolyzed by oral microbial enzymes. Very little is known about the endogenous proteolytic processing of gluten proteins in the oral cavity. Given that this occurs prior to gluten reaching the small intestine, such enzymes are likely to contribute to the composition of the gluten digest that ultimately reaches the small intestine and causes CD. We demonstrated that endogenous salivary protease activities are incomplete, likely liberating peptides from larger gluten proteins. The potentially responsible microbes were identified. The study included refractory CD patients, who have been studied less with regard to CD pathogenesis.
authors.affiliation: Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Tian
authors.affiliation: The Forsyth Institute, Department of Microbiology, Cambridge, Massachusetts, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Faller
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ciaran P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.|Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jos A
authors.initials: JA
authors.lastname: Bosch
authors.affiliation: Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Guoxian
authors.initials: G
authors.lastname: Wei
authors.affiliation: The Forsyth Institute, Department of Microbiology, Cambridge, Massachusetts, USA.|Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Paster
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.|Institute of Translational Immunology and Research Center for Immunotherapy (FZI), University Medical Center, Mainz, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.affiliation: Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA helmer@bu.edu.
authors.forename: Eva J
authors.initials: EJ
authors.lastname: Helmerhorst
mesh_terms: D000328:Adult; D000368:Aged; D058491:Bacterial Load; D002446:Celiac Disease / Q000382:microbiology*; D005260:Female; D005903:Gliadin / Q000378:metabolism*; D005983:Glutens / Q000378:metabolism*; D006801:Humans; D006868:Hydrolysis; D007413:Intestinal Mucosa / Q000378:metabolism; D007778:Lactobacillus / Q000145:classification* / Q000302:isolation & purification / Q000378:metabolism*; D008297:Male; D064307:Microbiota / Q000235:genetics / Q000502:physiology; D008875:Middle Aged; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012463:Saliva / Q000201:enzymology / Q000378:metabolism / Q000382:microbiology; D055815:Young Adult
chemical_list: D012336:RNA, Ribosomal, 16S; D005983:Glutens; D005903:Gliadin
keywords: 16S rRNA; celiac disease; enzyme; microbiome; saliva