Researchers from Mass General for Children and Italy have made an important discovery in the field of celiac disease. Through the use of blood samples and comprehensive data from the Celiac Disease Genomic, Environmental, Microbiome and Metabolomic (CDGEMM) Study, the researchers have identified a potential biomarker that precedes the development of celiac disease autoimmunity in children. This biomarker is an increase in intestinal permeability, which is a physiological precursor to celiac disease.
The findings of the study were published in the journal Pediatrics under the title “Zonulin as a Biomarker for the Development of Celiac Disease”. The research found that levels of zonulin, a widely used marker of intestinal permeability, were higher in children at 18 months of age who later developed celiac disease.
Dr. Maureen Leonard, the clinical director at the Center for Celiac Research and Treatment at Mass General for Children and senior author of the study, explains that increased intestinal permeability, as measured by zonulin levels, is often observed in chronic inflammatory diseases. Therefore, the finding of increased zonulin levels in children who are at risk of developing celiac disease suggests that zonulin could be used as a biomarker to screen at-risk children.
To conduct the study, the researchers examined data from 102 children who were at risk of celiac disease and were enrolled in the CDGEMM Study. Half of the children had developed celiac disease autoimmunity, while the other half had not. The researchers measured zonulin levels in the blood samples taken from the children from the age of 12 months until the onset of celiac disease autoimmunity or the corresponding time point in the control group.
In addition to studying zonulin levels, the researchers also investigated the influence of environmental factors on zonulin levels, particularly the use of antibiotics in infancy. The study found a correlation between a greater number of courses of antibiotics and higher zonulin levels in the children who later developed celiac disease autoimmunity, compared to the control group.
The findings of this study align with previous research conducted in Denmark and Norway, which also showed a rise in zonulin levels in infants with a higher use of antibiotics before the development of celiac disease autoimmunity. This association highlights the importance of reducing unnecessary antibiotic use to prevent the development of celiac disease.
The CDGEMM Study was initiated in 2013 by Dr. Alessio Fasano and Dr. Maureen Leonard to investigate the progression from genetic predisposition to celiac disease. Over 600 children and infants from the US and Italy, who have a first-degree relative with celiac disease, have participated in the study by providing blood, stool, and tissue samples, as well as extensive environmental and clinical information.
Dr. Fasano, the director of the Center for Celiac Research and Treatment, explains that the goal of the study is to understand the early steps in celiac disease autoimmunity in order to prevent its development. By identifying those who are at risk of developing celiac disease autoimmunity and taking steps to prevent it, the researchers hope to reduce the incidence of celiac disease in children.
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