The Molecular Basis for Oat Intolerance in Patients with Celiac Disease

Abstract

BackgroundCeliac disease is a small intestinal inflammatory disorder characterized by malabsorption, nutrient deficiency, and a range of clinical manifestations. It is caused by an inappropriate immune response to dietary gluten and is treated with a gluten-free diet. Recent feeding studies have indicated oats to be safe for celiac disease patients, and oats are now often included in the celiac disease diet. This study aimed to investigate whether oat intolerance exists in celiac disease and to characterize the cells and processes underlying this intolerance.Methods and FindingsWe selected for study nine adults with celiac disease who had a history of oats exposure. Four of the patients had clinical symptoms on an oats-containing diet, and three of these four patients had intestinal inflammation typical of celiac disease at the time of oats exposure. We established oats-avenin-specific and -reactive intestinal T-cell lines from these three patients, as well as from two other patients who appeared to tolerate oats. The avenin-reactive T-cell lines recognized avenin peptides in the context of HLA-DQ2. These peptides have sequences rich in proline and glutamine residues closely resembling wheat gluten epitopes. Deamidation (glutamine→glutamic acid conversion) by tissue transglutaminase was involved in the avenin epitope formation.ConclusionsWe conclude that some celiac disease patients have avenin-reactive mucosal T-cells that can cause mucosal inflammation. Oat intolerance may be a reason for villous atrophy and inflammation in patients with celiac disease who are eating oats but otherwise are adhering to a strict gluten-free diet. Clinical follow-up of celiac disease patients eating oats is advisable.

A dietary survey to determine if patients with coeliac disease are meeting current healthy eating guidelines and how their diet compares to that of the British general population

“…Recent research is persuasive in suggesting that most adults can tolerate moderate (o50 g/day) amounts of oats safely and it is now advised that oats can be included as they add fibre and variety. Some patients may however get a reaction (Storsrud et al, 2003;Arentz-Hansen et al, 2004;Silano et al, 2007). An additional problem is cross-contamination due to the harvesting, storage and milling process.…”

Effects of genetic and agronomic factors on grain composition in oats

“…They also represent a source of good quality storage proteins and other compounds with func-tional properties, like unsaturated lipids, antioxidants and vitamins (Peterson 1992). The interest in oats for food industries is increasing with the numerous evidences of its beneficial effects on health (Davy et al 2002;Jenkins et al 2002), mainly associated with the protein and b-glucan functionality and their potential use in the diet of people with celiac disease (Arentz-Hansen et al 2004;Haboubi et al 2006). As a part of a large project aimed at opening new commercial opportunities for oats grain, the possible use of naked oats as raw materials was studied (Sgrulletta et al 2005;Redaelli et al 2006).…”

Nutrient intakes during diets including unkilned and large amounts of oats in celiac disease

“…Lundin et al (2003) reported that 1 of 19 patients in remission developed villous atrophy and dermatitis herpetiformis after consuming 50 g of oats per day. In another study, (Arentz-Hansen et al, 2004) three of nine patients who also developed villous atrophy with oats challenge, as well as two other patients who appeared to tolerate oats, were shown to have oat avenin-specific and reactive intestinal T-cell lines. In this study, an old woman withdrew because of vomiting during 1 day.…”