Gluten-Free Diet Induces Rapid Changes in Phenotype and Survival Properties of Gluten-Specific T Cells in Celiac Disease.
Study Goal
The researchers aimed to examine how gluten-specific T cells transition into memory T cells and how clinically relevant biomarkers normalize during the first year of a gluten-free diet in celiac disease patients.
Results Summary
The study found that gluten-specific CD4+ T cells peaked in blood at day 14, then decreased within 10 weeks of a gluten-free diet, with rapid changes in T-cell phenotype and disease-specific antibodies. These changes suggest a shift to a quiescent but chronic state in treated celiac disease.
Population
17 celiac disease patients (with additional assessments in subsets of 6 and 9 patients).
Effective Dosage
Not specified (gluten-free diet adherence).
Duration
1 year (with some assessments within the first 3 weeks).
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten-free diet (GFD) | decrease | gut inflammation | celiac disease (CeD) patients | - | normalizes | #1 |
gluten-free diet (GFD) | decrease | disease-specific antibodies | celiac disease (CeD) patients | - | normalizes | #2 |
gluten-free diet (GFD) | increase | gluten-specific CD4+ T cells in blood | CeD patients | day 14 | peaked | #3 |
gluten-free diet (GFD) | increase | Bcl-2 | CeD patients | - | up-regulating | #4 |
gluten-free diet (GFD) | decrease | Ki-67 | CeD patients | - | down-regulating | #5 |
gluten-free diet (GFD) | decrease | gluten-specific CD4+ T cells | CeD patients | within 10 weeks | decreased in frequency | #6 |
gluten-free diet (GFD) | decrease | CD38 in gluten-specific cells | CeD patients | within 3 days | decreased | #7 |
gluten-free diet (GFD) | decrease | ICOS in gluten-specific cells | CeD patients | within 3 days | decreased | #8 |
gluten-free diet (GFD) | decrease | HLA-DR in gluten-specific cells | CeD patients | within 3 days | decreased | #9 |
gluten-free diet (GFD) | decrease | Ki-67 in gluten-specific cells | CeD patients | within 3 days | decreased | #10 |
gluten-free diet (GFD) | no change | PD-1 expression | CeD patients | even after 12 months | persisted | #11 |
gluten-free diet (GFD) | no change | CD39 expression | CeD patients | even after 12 months | persisted | #12 |
gluten-free diet (GFD) | no change | OX40 expression | CeD patients | even after 12 months | persisted | #13 |
gluten-free diet (GFD) | decrease | IgA-transglutaminase 2 | CeD patients | within 4 weeks | decreased significantly | #14 |
BACKGROUND & AIMS: The treatment of celiac disease (CeD) with gluten-free diet (GFD) normalizes gut inflammation and disease-specific antibodies. CeD patients have HLA-restricted, gluten-specific T cells persisting in the blood and gut even after decades of GFD, which are reactivated and disease driving upon gluten exposure. Our aim was to examine the transition of activated gluten-specific T cells into a pool of persisting memory T cells concurrent with normalization of clinically relevant biomarkers during the first year of treatment. METHODS: We followed 17 CeD patients during their initial GFD year, leading to disease remission. We assessed activation and frequency of gluten-specific CD4+ blood and gut T cells with HLA-DQ2.5:gluten tetramers and flow cytometry, disease-specific serology, histology, and symptom scores. We assessed gluten-specific blood T cells within the first 3 weeks of GFD in 6 patients and serology in an additional 9 patients. RESULTS: Gluten-specific CD4+ T cells peaked in blood at day 14 while up-regulating Bcl-2 and down-regulating Ki-67 and then decreased in frequency within 10 weeks of GFD. CD38, ICOS, HLA-DR, and Ki-67 decreased in gluten-specific cells within 3 days. PD-1, CD39, and OX40 expression persisted even after 12 months. IgA-transglutaminase 2 decreased significantly within 4 weeks. CONCLUSIONS: GFD induces rapid changes in the phenotype and number of gluten-specific CD4+ blood T cells, including a peak of nonproliferating, nonapoptotic cells at day 14. Subsequent alterations in T-cell phenotype associate with the quiescent but chronic nature of treated CeD. The rapid changes affecting gluten-specific T cells and disease-specific antibodies offer opportunities for clinical trials aiming at developing nondietary treatments for patients with newly diagnosed CeD.