DNA damage, oxidative stress, and inflammation in children with celiac disease

Faecal biomarkers in children with coeliac disease: A way forward?

AIM

Novel markers to reflect the intestinal damage in coeliac disease are needed. We studied the potential of faecal and serum neopterin, and faecal myeloperoxidase, human β-defensin-2, and lipocalin-2 in a case-control study.

METHODS

Data were collected from medical records and a biobank including newly diagnosed coeliac disease patients, potential coeliac disease patients and non-coeliac controls. Commercially available ELISA assays were used for measuring the biomarkers.

RESULTS

Altogether 19 patients with coeliac disease (median age 9.0 years), 8 with potential coeliac disease (4.0 years) and 18 controls (6.5 years) were included. The highest faecal neopterin levels were seen in potential coeliac disease, followed by controls and coeliac disease (median 513 vs. 372 vs. 255 nmol/L, respectively, p = 0.016). Also, serum neopterin was highest in the potential coeliac disease group (9.8 vs. 5.5 vs. 5.9 nmol/L, p = 0.022). After age adjustment and robust variance estimation, only differences in serum neopterin remained significant. Other markers did not differ between the groups. None of the markers were significantly associated with serum transglutaminase-2 antibody levels.

CONCLUSION

Differences in neopterin levels amongst patients with potential coeliac disease, coeliac disease, and controls suggest that neopterin might serve as an early disease marker.

Review article: Faecal biomarkers for assessing small intestinal damage in coeliac disease and environmental enteropathy

BACKGROUND

In coeliac disease and environmental enteropathy, dietary gluten and enteric infections cause reversible inflammation and morphological changes to the small intestinal mucosa that can be detected in biopsy samples obtained by endoscopy. However, there is a clear need for non-invasive biomarkers. Constant shedding of mucosal material into the bowel lumen and faeces, together with easy availability of stool, makes it an interesting sample matrix.

AIMS

To conduct a systematic literature search and summarize the existing evidence for host mucosa-derived faecal biomarkers in evaluating small intestinal damage.

METHODS

We searched for studies on PubMed (MEDLINE) until 1 March 2024.

RESULTS

We identified 494 studies and included 35 original case-control and cohort studies. These assessed host mucosal transcripts and 14 other markers aiming specifically to reflect inflammation and cell-mediated, innate and gluten-induced immune responses. In coeliac disease, faecal calprotectin and anti-gliadin, tissue transglutaminase, endomysium and deamidated gliadin peptide antibodies were the most studied but with inconsistent results. Single studies reported positive findings about microRNA transcripts, β-defensin-2, lipocalin-2, zonulin-related proteins and angiotensin-converting enzyme. In environmental enteropathy, a non-significant association was reported between calprotectin and urine lactulose/mannitol ratio; there were conflicting results for neopterin, myeloperoxidase and host transcripts. Single studies reported a positive association for lactoferrin, and a negative association for regenerating islet-derived protein 1. Studies comparing faecal markers against small intestinal biopsy findings were not identified in environmental enteropathy.

CONCLUSIONS

Further studies are needed to determine reliable faecal markers as a proxy for small intestinal mucosal damage.

Plant-Based Antioxidants in Gluten-Free Bread Production: Sources, Technological and Sensory Aspects, Enhancing Strategies and Constraints

The recognized contribution of antioxidant compounds to overall health maintenance and spotted deficiencies in celiac patients' diets has driven more intensive research regarding antioxidant compounds' inclusion in gluten-free bread (GFB) production during the last decade. The presented review gathered information that provided insights into plant-based antioxidant sources which are applicable in GFB production through the resulting changes in the technological, sensory, and nutritional quality of the resulting antioxidant-enriched GFB. The influence of the bread-making process on the antioxidant compounds' content alteration and applied methods for their quantification in GFB matrices were also discussed, together with strategies for enhancing the antioxidant compounds' content, their bioaccessibility, and their bioavailability, highlighting the existing contradictions and constraints. The addition of plant-based antioxidant compounds generally improved the antioxidant content and activity of GFB, without a profound detrimental effect on its technological quality and sensory acceptability, and with the extent of the improvement being dependent on the source richness and the amount added. The determination of a pertinent amount and source of plant-based antioxidant material that will result in the production of GFB with desirable nutritional, sensory, and technological quality, as well as biological activity, remains a challenge to be combated by elucidation of the potential mechanism of action and by the standardization of quantification methods for antioxidant compounds.

Salivary Alterations of Myeloperoxidase in Patients with Systemic Diseases: A Systematic Review

Salivary myeloperoxidase (MPO) is a key mediator of the oral immune system, acting as an enzyme that utilises H2O2 to generate molecules with high bactericidal activity. While MPO determination in plasma is quite common, the use of saliva is still rare. Our systematic review was designed to answer the question "Are salivary levels of myeloperoxidase altered in patients with systemic diseases?". Following the inclusion and exclusion criteria, we included twenty-six studies. Altered MPO levels in saliva were most commonly found in patients with cardiovascular and gastrointestinal diseases. Most studies concerned unstimulated whole saliva, and only a few of them stimulated, mainly by chewing paraffin. Enzyme-linked immunosorbent assay (ELISA) was the most common method for determination of MPO concentrations in saliva. Increased salivary MPO levels were more often observed for inflammatory diseases, except patients with inflammatory bowel diseases who were eligible for biologic therapy. In conclusion, MPO could be altered in the saliva of patients with systematic diseases, especially cardiovascular or gastrointestinal diseases. However, further investigations are recommended to validate these outcomes.

Phenolic Compounds and Antioxidant Status of Cookies Supplemented with Apple Pomace

The post-production leftovers after the pressing of apple juice are a rich source of health-promoting compounds, which could be used in the food industry for the manufacture of dietary foods, applicable also for people with celiac disease. This raw material is currently little used, and the cost of its disposal is considerable. Therefore, an attempt was made to enrich gluten-free cookies with different proportions of apple pomace. The content of individual polyphenols determined by the UPLC-PDA-MS/MS method, basic chemical composition, physical properties of cookies with 15%, 30%, 45%, and 60% apple pomace, were evaluated. It was found that apple pomace in gluten-free cookies caused an increase in the content of phenolic acids, quercetin derivatives, flavan-3-ols and dihydrochalcones. An elevation in protein, fat, and minerals was also observed. The growing share of apple pomace caused a significant increase in the content of total fiber, soluble, and insoluble fractions, but resulted in an increase in the hardness and darkening of the cookies while reducing their volume.

High Frequency of Glucose-6-Phosphate Dehydrogenase Deficiency in Patients Diagnosed with Celiac Disease

Celiac disease (CD) is characterized by a proinflammatory state associated with the production of reactive oxygen species, i.e., a condition of oxidative stress. In this study, we tested the hypothesis that the inherited deficiency of glucose-6-phosphate dehydrogenase (G6PD), by causing impaired antioxidant defense, may increase the risk of CD.

METHODS

A retrospective monocentric case-control study was performed using the clinical records of 8338 outpatients (64.6% women) scheduled for upper endoscopy between 2002 and 2021 in Northern Sardinia. Overall, 627 were found to have CD (7.5%), and 1027 resulted to be G6PD-deficiency carriers (12.3%). Since randomization was impractical, the potential covariates imbalance between cases and controls was minimized using a 1:2 propensity-score-matched (PSM) analysis.

RESULTS

Overall, G6PD deficiency was associated with increased risk of CD (odds ratio (OR) 1.50; 95% confidence interval (CI) 1.19-1.90). The PSM procedure identified 1027 G6PD-deficient and 2054 normal patients. Logistic regression including the propensity score detected for G6PD deficiency an OR of 1.48 (95%CI 1.13-1.95; p = 0.004).

CONCLUSIONS

Our findings show that the enzyme defect was significantly and positively associated with CD, in line with the pro-oxidant impact of the enzyme defect observed in animal models and humans.

Pigmented Corn Varieties as Functional Ingredients for Gluten-Free Products

Oxidative stress, one among the several factors responsible for the gluten toxicity in celiac disease, together with inflammation and duodenal mucosal injury, are only partially reduced by the gluten-free diet. Thanks to their phenolic profile, the pigmented varieties of corn could be an interesting source of dietary antioxidants for the formulation of new gluten-free ingredients. The aim of this research was: (1) to characterize the phenolic profile and the associated antioxidant properties of corn samples with different pigmentation, using spectrophotometric and chromatographic techniques and (2) to assess the stability of anthocyanins during the gastro-intestinal digestion. The pigmented varieties showed a significantly higher content of polyphenols compared to the common yellow varieties and, as a consequence, a higher antioxidant activity. Although corn is among the cereals most frequently used in gluten-free products, it can produce an inflammatory response in some celiac patients. Therefore, after the chemical characterization, the safety of the pigmented varieties for celiac patients was confirmed using different in vitro models (cell agglutination test and the measure of transepithelial electrical resistance). Although in vivo studies are necessary, the data collected in this study underline that the pigmented corn could have a role in reducing the oxidative stress at the intestinal level in celiac subjects.

Programmed Cell Death in the Small Intestine: Implications for the Pathogenesis of Celiac Disease

The small intestine has a high rate of cell turnover under homeostatic conditions, and this increases further in response to infection or damage. Epithelial cells mostly die by apoptosis, but recent studies indicate that this may also involve pro-inflammatory pathways of programmed cell death, such as pyroptosis and necroptosis. Celiac disease (CD), the most prevalent immune-based enteropathy, is caused by loss of oral tolerance to peptides derived from wheat, rye, and barley in genetically predisposed individuals. Although cytotoxic cells and gluten-specific CD4⁺ Th1 cells are the central players in the pathology, inflammatory pathways induced by cell death may participate in driving and sustaining the disease through the release of alarmins. In this review, we summarize the recent literature addressing the role of programmed cell death pathways in the small intestine, describing how these mechanisms may contribute to CD and discussing their potential implications.

Apple Pomace as a Source of Bioactive Polyphenol Compounds in Gluten-Free Breads

Gluten-free products based on starch and hydrocolloids are deficient in nutrients and do not contain pro-health substances. Therefore, they should be enriched in raw materials naturally rich in antioxidants, especially if they are intended for celiac patients, prone to high oxidative stress. Apart from the traditionally used pseudo-cereals, seeds, vegetables and fruits, innovative substrates such as the by-product (especially in Poland) dry apple pomace could be applied. The study material consisted of gluten-free bread enriched with apple pomace. The content of individual polyphenols, the content of total polyphenol and flavonoids, and also the antioxidant potential of the bread were determined by the UPLC-PDA-MS/MS methods. It was observed that apple pomace was a natural concentrate of bioactive substances from the group of polyphenols. In summary, gluten-free bread with 5% content of apple pomace showed the highest organoleptic scores and contained high levels of phenolic compounds. The values of total phenolic content, and the amounts of flavonoids, phenolic acids and phloridzin in this bread were 2.5, 8, 4 and 21 times higher in comparison to control.