Celiac disease is not just genetic
Celiac disease is often considered to have a genetic cause. It is a chronic systemic autoimmune disease that is characterized by loss of tolerance to dietary gluten. Although it occurs in genetically predisposed individuals, not every predisposed person develops the disease and there is substantial variability in both age of onset and symptom severity (1). The only available treatment is a gluten-free diet (GFD), but 30-40% of patients on a GFD continue to experience symptoms (1). A large body of evidence shows that the gut microbiome plays a significant role in the development of celiac disease (1,2). For example, it is known that gut dysbiosis precedes the onset of the disease, whereas genetically predisposed individuals who do not have dysbiosis remain healthy (3,4). Moreover, it is known that GFD has a beneficial effect on the microbiome composition and function but does not fully restore it (5). It can be argued that the beneficial effect of GFD is at least in part due to its effect on the gut microbiome and is not just due to the absence of immune-triggering gluten proteins. In line with this, scientific studies conclude that it is worthwhile considering treatment of the gut microbiome in patients with celiac disease.
New probiotic strain alleviates celiac disease and gluten sensitivity symptoms
Unfortunately, not many probiotics have been studied for their effect on celiac disease, with only a few exceptions. The currently best studied probiotic in celiac disease is Bifidobacterium longum ES1 (CETCT 7374). About a dozen in vitro and animal studies have shown his strain’s capability to degrade gliadin and to modulate immune responses to gluten (see e.g. 6-8). In addition, a small RCT in children with newly diagnosed celiac disease comparing GFD with GFD + B. longum ES1 showed that in the probiotic group important improvements were found in specific immune cells involved in the disease symptoms (9). In addition, pro-inflammatory cytokines were substantially lower in the group receiving the B. longum ES1 (9). Moreover, an open-label study in patients with non-celiac gluten sensitivity showed that compared to GFD only, the group on GFD + B. longum ES1 had more improvements in gastrointestinal symptoms (10). This strain is now available on the Microbiome Center platform. Although it will not be able to replace GFD, it can support patients with celiac disease or gluten sensitivity in further alleviating symptoms. This interesting probiotic strain also has good quality evidence for an effect on IBS, including diarrhea and abdominal pain (11,12), as well as on various other indications. For more information, see the detailed description behind the i-button on the Microbiome Center platform.
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References:
- https://doi.org/10.3389/fmedt.2024.1413637
- https://doi.org/10.1007/s00430-017-0496-z
- https://doi.org/10.1073/pnas.2020322118
- https://doi.org/10.1128/spectrum.01468-24
- https://doi.org/10.3390/nu14102083
- https://doi.org/10.1021/jf201212m
- https://doi.org/10.1016/j.ijbiomac.2010.06.015
- https://doi.org/10.1189/jlb.1111581
- https://doi.org/10.1017/S0007114514000609
- https://doi.org/10.23736/S1121-421X.20.02673-2
- https://doi.org/10.1080/19490976.2024.2338322
- https://doi.org/10.3390/jcm9082353