Immunological indicators of coeliac disease activity are not altered by long-term oats challenge

Abstract

Coeliac disease is a gluten-sensitive enteropathy that develops in geneti- cally susceptible individuals. The disease exhibits many features of an autoimmune disorder. These include the production of highly specific anti- endomysial autoantibodies directed against the enzyme tissue transglutami- nase. It is well accepted that wheat-, barley- and rye-based foods should be excluded in the gluten-free diet. Although several studies report that oats ingestion is safe in this diet, the potential toxicity of oats remains controver- sial. In the current study, 46 coeliac patients ingested oats for 1 year and were investigated for a potential immunogenic or toxic effect. Stringent clinical monitoring of these patients was performed and none experienced adverse effects, despite ingestion of a mean of 286 g of oats each week. Routine histo- logical analysis of intestinal biopsies showed improvement or no change in 95% of the samples examined. Furthermore, tissue transglutaminase expres- sion in biopsy samples, determined quantitatively using the IN Cell Analyzer, was unchanged. Employing immunohistochemistry, oats ingestion was not associated with changes in intraepithelial lymphocyte numbers or with ente- rocyte proliferation as assessed by Ki-67 staining. Finally, despite the poten- tial for tissue transglutaminase to interact with oats, neither endomysial nor tissue transglutaminase antibodies were generated in any of the patients throughout the study. To conclude, this study reaffirms the lack of oats immunogenicity and toxicity to coeliac patients. It also suggests that the antigenic stimulus caused by wheat exposure differs fundamentally from that caused by oats