Archiwa

International Celiac Disease Day is celebrated on May 16 in all countries belonging to the AOECS. Established in 2006, it draws attention to gluten-dependent diseases and the challenges faced by consumers following a gluten-free diet, but also by food producers, for whom the market has growing expectations. Dr. Urszula Krupa-Kozak from the Department of Chemistry and Biodynamics of Food, talks about celiac disease and the relevant research being conducted at our Institute.

Many people who consume grain products report distressing symptoms, worsening health and reduced quality of life. Gluten, which is a complex of wheat reserve proteins (gliadin and glutein) and the homologous proteins of rye (secalin) and barley (hordein), can cause the development of gluten-dependent diseases, which include celiac disease, Dühring syndrome, gluten ataxia, wheat allergy and non-celiac gluten hypersensitivity. Celiac disease (a.k.a. visceral disease, gluten-dependent enteropathy) is an autoimmune disease that occurs in genetically predisposed individuals, caused by persistent gluten intolerance. The disease is characterized by a varied clinical picture, the presence of specific serum antibodies and haplotype (group of genes inherited from one parent – ed.) HLADQ2 or HLA-DQ8, and enteropathy (pathological changes – ed.) in the small intestine. The disease leads to damage to the intestinal mucosa, followed by atrophy of the intestinal villi, whose function is to absorb nutrients.

Diagnosis

Gluten-dependent diseases can manifest themselves with different symptoms, which can additionally vary in severity. Classic celiac disease (full-blown) is characterized by symptoms of malnutrition, abdominal pain, weight loss; it is accompanied by diarrhea, bloating, and in children, personality changes and developmental disorders. This form of the disease is relatively rare, and is diagnosed relatively quickly due to its characteristic symptoms. Much more often, however, patients with celiac disease have extraintestinal symptoms (anemia, chronic fatigue, aphthas, neurological disorders, bone and joint pain, premature osteoporosis, fertility problem), which should draw the attention not only of gastroenterologists, but also of endocrinologists, gynecologists, hematologists, rheumatologists or neurologists. Non-celiac gluten hypersensitivity (NCGS) is characterized by symptoms similar to celiac disease and irritable bowel syndrome, with which it can be confused. The condition mainly affects adults and is characterized by symptoms beyond the gastrointestinal tract.

People who observe alarming symptoms in themselves after consuming gluten-containing products and suspect the development of gluten-related diseases should consult their GP. The doctor, based on the medical history, will order a consultation with a specialist – a gastroenterologist in a justified case. The specialist in the next step will order the determination of celiac disease-specific antibodies (tTG and EmA), the presence of which in the blood serum indicates the disease, but does not always mean changes in the small intestine, authorizing its diagnosis. Therefore, for a complete diagnosis of celiac disease, biopsy and histopathological evaluation of small intestine sections, which are the gold standard for diagnosis in adults, are necessary. In the case of NCGS, diagnosis relies on the exclusion of other gluten-dependent diseases (celiac disease and wheat allergy), as there are no specific markers to detect this type of hypersensitivity.

What’s next?

For gluten-dependent diseases, the basic and common form of therapy is to exclude gluten from the diet. The differences, however, are that in the case of celiac disease, a gluten-free diet must already be followed rigorously and for life, while in the case of allergies and NCGS, the diet can be followed temporarily.

A gluten-free diet involves eliminating foods made from grains, i.e. wheat (including spelt, flatbread, semolina), barley, rye and uncertified oats. Commercially, gluten-free products are marked with a crossed ear sign. However, unlabeled products can be a problem, especially those in which gluten is not expected such as cured meats, sauces, spice blends, dressings, yogurts or gum, and even some medicines that may have been contaminated with this protein in the manufacturing process.

In the initial stages of treatment, right after diagnosis, the support of a qualified nutritionist is very important and helpful in properly balancing a gluten-free diet. However, once you become familiar and „accustomed” to its principles, following the diet in your own home becomes a habit. Meals away from home, in restaurants, at school/preschool or while traveling can be a problem. That’s why it’s a good idea to ensure your safety by planning your meals well, choosing only reliable restaurants and catering companies. Although products with the crossed-thorn mark are now available for purchase, it is advisable to prepare a set of tried-and-true gluten-free products for trips, consisting, for example, of bread, cookies, nuts and fruit. It’s also a good idea to be mindful of your diet when traveling by air and to book a gluten-free meal in advance.

Trendy „gluten-free”

Without consulting a gastroenterologist and without a definitive diagnosis, you should not switch to a gluten-free diet on your own. This will make it more difficult and prolong the time for a proper diagnosis because when we eliminate gluten from the diet, the body will not be in contact with this factor and will stop producing characteristic antibodies, so that the results of serological tests will be inaccurate or falsely negative.

Flaxseed cake as an opportunity to improve gluten-free products

Recent research conducted by scientists at the Institute of Animal Reproduction and Food Research, in cooperation with the West Pomeranian University of Technology, has focused on improving the quality and enrichment of gluten-free baked goods with nutrients and bioactive ingredients derived from flaxseed cake, the pomace from linseed oil production. Compared to conventional bread, a common disadvantage of commercially available gluten-free baked goods is poor quality due to inferior taste, unsatisfactory texture and reduced nutritional value and short shelf life. The need to improve the quality of baked goods led researchers to study the nutritional and functional potential of flaxseed cake, which has been shown to be a good source of minerals and antioxidants. In addition, along with flaxseed cake, proteins and polysaccharides are introduced into bread recipes, which have a beneficial effect on the technological properties of bread, giving it the desired cohesiveness, porosity, colour and even aroma. The research conducted by the teams from Olsztyn and Szczecin is important from the point of view of consumers on a gluten-free diet, who have the right to expect that the quality of gluten-free products available commercially will be similar to conventional products. In reality, however, this is not easy to achieve and poses a great challenge for food technologists and producers.

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Until recently, it was believed that if a woman had a problem with heavy menstrual bleeding, fertility or menstrual pain, then „this is her beauty”. Today we know that these may be symptoms of, for example, adenomyosis – a female disease similar to endometriosis. The research results of scientists from the Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences in Olsztyn may improve the diagnosis and treatment of this condition.

The publication on this topic appeared in the journal „Journal of Clinical Medicine” .

ADENOMMYOSIS – A LESS KNOWN FORM OF ENDOMETRIOSIS

Adenomyosis is an estrogen-dependent disease similar to endometriosis. In endometriosis, endometrial tissue, the lining inside the uterus, abnormally migrates to other places in the body, including the intestines or around the anus. With adenomyosis, these tissues get into in the uterine muscle – explains the author of the study, Maria Sztachelska, MD, PhD from the Department of Biology and Pathology of Human Reproduction IRZiBŻ PAS in Olsztyn.

The main symptoms of adenomyosis are very heavy menstrual bleeding, perimenstrual pain and pain during intercourse, thickening of the uterine walls in the ultrasound image, infertility problems, general malaise, and a tendency to anemia.

The exact mechanism of adenomyosis formation is not yet known. As Maria Sztachelska emphasizes, one of the theories is the presence of excessive contractile activity of the uterus, which leads to micro-trauma and the mucous membrane tissue inside the uterus instead of exfoliating outside (during menstruation) penetrates inside this wall.

(NOT) ESSENTIAL ESTROGEN

Adenomyosis is an estrogen-dependent disease, which means that estrogens are the key hormones driving its growth.

“In our studies, we wanted to determine the profile of hormone receptors and we showed the presence of all nuclear and membrane estrogen and progesterone receptors. We suspect that in the case of adenomyosis – as in endometriosis – the mechanism of disease formation is most likely related to the expression of the beta estrogen receptor, which is not present in the normal endometrium – the researcher points out.

Studies have also shown that adenomyosis is able to drive its own development, because its tissues themselves produce estradiol (biologically active estrogen), and this promotes cell proliferation. – In addition, adenomyosis also produces prolactin, which inhibits apoptosis, i.e. the process of cell destruction. All this increases the lifespan of adonemiosis and therefore its complete recovery is still a challenge – emphasizes Maria Sztachelska.

BETTER DIAGNOSIS AND TARGETED THERAPY

Currently, adenomyosis can be treated in two ways. The first path is radical, surgical treatment.

– The second option, often used after the procedure, is pharmacological treatment. Currently, the therapy most often consists in the use of GnRH antagonists, which inhibit the production of estradiol. However, they cannot be used indefinitely, because estradiol is necessary for a woman – it affects e.g. skin, hair, nails, well-being. Our previous research, led by Dr. Donata Ponikwicka-Tyszko, on the biology of endometriosis, indicates that GnRH antagonist therapy in combination with estradiol can be used long-term and has good effects. Currently, the potential of targeted therapy, e.g. in the form of antibodies directed at specific receptors, is also being investigated, emphasizes Maria Sztachelska.

The test results may also contribute to better diagnosis. „Since we showed a high expression of the estrogen receptor beta, knowing this altered profile of receptors, it would be possible to determine whether a woman is potentially at risk of adenomyosis by examining the endometrial tissue taken in a biopsy, even before the onset of symptoms” – the researcher points out.

– Until recently, it was believed that if a woman has a problem with heavy menstrual bleeding, fertility or menstrual pain, then „this is her beauty”. Fortunately, today the awareness and detection of endometriosis or adenomyosis is increasing. And this is not a marginal problem, because these diseases can affect up to every fifth woman – sums up Maria Sztachelska.

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Lymphocytes are white blood cells that regulate the immune system. If they have some „experience”, e.g. with an allergenic protein and get transplanted into another organism, then such a transfer will strengthen the immune reaction and the body will start to defend itself better against this protein.

Such an experiment was conducted by scientists from our Institute. They showed that transplanted CD4+ T cells that were in contact with hen’s egg white enhanced the immune response to it. The results were published in the International Journal of Molecular Science.

– The results of our research may be a step towards developing methods of treating patients with allergies – emphasizes the author of the research, Dr. Dagmara Złotkowska from the Department of Immunology and Food Microbiology IAR&FR PAS in Olsztyn.

HOW ALLERGIES HAPPEN

A food allergy is an abnormal reaction of the body’s immune system to a specific compound, which is an allergen. So it is a type of food hypersensitivity that causes unwanted food reactions, involving the immune system.

In the fight against food allergies, T lymphocytes, i.e. white blood cells, play an important role in regulating the immune system response. – This is a group of cells specializing in defending our body against the undesirable effects of potential allergens – explains Dr. Dagmara Złotkowska.

If we „teached” cells how to recognize and neutralize specific allergenic proteins, these „teachers” could be transferred (e.g. in the form of vaccines) to the body of allergy sufferers to minimize its immune response. – This can be compared to the mechanism of the mRNA vaccine against COVID-19, where – to put it simply – we do not provide the cells with a virus, but with a „set of instructions” on how to produce antibodies – the researcher points out.

EXPERIMENTAL TRANSFER

The team from the Department of Immunology and Food Microbiology of IAR&FR PAS in Olsztyn focused on allergy to hen’s egg protein and the possibility of cross-reactivity with chicken meat proteins. This meat is a common component of the modern diet; allergy to them is relatively rare and occurs independently or in people allergic to egg white (OVA, or ovalbumin, is the main protein found in egg white). CD4+ T cells, on the other hand, are special immune cells that recognize allergens, including the OVA protein.

The experiment involved transplanting experienced (those that had already been in contact with OVA) CD4+ T cells into the body of an animal that was allergic to OVA and fed chicken meat. – It turned out that such a transfer helped to improve the negative immune response to OVA, that is, it strengthened the body’s immune response to the OVA protein, which was previously not recognized and fought off by the immune system. To put it simple, the body began to defend itself better against this protein – indicates Dr. Dagmara Złotkowska.

A CURE FOR FOOD ALLERGY?

The approach of the researchers from Olsztyn is innovative and may contribute to the development of treatment methods for patients with allergies. – So far, the most effective way to treat food allergy is to exercise the elimination diet – which eliminates not only allergens, but also other cross-reacting proteins. I doubt whether we will find a „cure” for allergy in the near future, because many factors and mechanisms affecting it are still not known. The results of our research may, however, be a step towards developing methods of treating patients with allergies, e.g. by giving them „trained” groups of cells that could reduce the immune response to a given allergen. There are still many years of research ahead of us, but the direction seems promising – the researcher concludes.

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