Celiac Study: Non-invasive Intestinal Evaluation Shows Promise

Celiac.com 05/21/2009 - To better diagnose celiac disease, assess intestinal damage, and monitor treatment over the long-term, doctors are looking to develop a whole new set of non-invasive evaluation tools.

One of the tools currently of interest are fatty acid binding proteins (FABPs), these are small cytosolic proteins found in enterocytes (tall columnar cells and responsible for the final digestion and absorption of nutrients, electrolytes and water). FABPs are reliable indicators of intestinal mucosal damage, and are potentially useful for non-invasive assessment of intestinal damage in celiac patients.

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A team of researchers in the Institute of Nutrition and Toxicology Research at Maastricht University, as well as the departments of Surgery, Pediatrics and Internal Medicine at University Hospital Maastricht, recently set out to assess the potential use of FABPs in non-invasive assessment of intestinal damage in celiac disease. The study team was made up of J. P. Derikx, A. C. Vreugdenhil, A. M. Van den Neucker, J.Grootjans J, A. A. van Bijnen, J.G. Damoiseaux, L. W. van Heurn, E. Heineman, and W. A. Buurman.

They began by examining the distribution and microscopic localization of FABPs in healthy human intestinal tissue. They then checked circulating levels of intestinal (I)-FABP and liver (L)-FABP in 26 healthy control subjects, and in 13 patients with biopsy-proven celiac disease, both before and after initiating a gluten-free diet.  Ten celiac subjects underwent reevaluation within a year beginning a gluten-free diet.

They found that I-FABP and L-FABP are common in the small intestine, particularly in the jejunum. FABPs also show up in cells on the upper part of the villi, the part that is first to be damaged in celiac disease.

They also found that people with untreated, biopsy-proven celiac disease have substantially higher circulating levels of FABPs as compared with healthy control subjects (I-FABP: 784.7 pg/mL vs. 172.7 pg/mL, P<0.001; L-FABP: 48.4 ng/mL vs. 10.4 ng/mL, P<0.001). These levels return to normal when patients adopt a gluten-free diet.
According to the team, the monitoring of FABP circulating levels shows strong promise as a non-invasive means of diagnosing and assessing intestinal damage in celiac disease, as well as in long-term non-invasive monitoring of treatment and gluten-free diet compliance.

Journal of Clinical Gastroenterology. 2009 Apr 6.