Wheat Amylase Trypsin Inhibitors as Nutritional Activators of Innate Immunity

Schuppan, Detlef; Zevallos, Victor F.

doi:10.1159/000371476

Cited by 70 publications

(83 citation statements)

References 19 publications

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“…40 This activation occurs both in vitro and in vivo after oral ingestion of purified ATIs or gluten, while gluten-free cereals display no or minimal activities. 61 The role of ATIs in IBS is not yet known, however there is clear description of a mechanism that could be involved in the generation of gut dysfunction and symptoms. These mechanisms are different from those proposed for gluten and thus it is conceivable that they could co-exist in given patients or have a synergistic effect.…”

Section: Experimental Evidence For a Role Of Wheat Components In Irrimentioning

confidence: 99%

Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?

Volta

Sánchez

Boschetti

et al. 2016

J Neurogastroenterol Motil

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A tight link exists between dietary factors and irritable bowel syndrome (IBS), one of the most common functional syndromes, characterized by abdominal pain/discomfort, bloating and alternating bowel habits. Amongst the variety of foods potentially evoking "food sensitivity", gluten and other wheat proteins including amylase trypsin inhibitors represent the culprits that recently have drawn the attention of the scientific community. Therefore, a newly emerging condition termed non-celiac gluten sensitivity (NCGS) or nonceliac wheat sensitivity (NCWS) is now well established in the clinical practice. Notably, patients with NCGS/NCWS have symptoms that mimic those present in IBS. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The present review aimed at providing an update to physicians and scientists regarding the following main topics: the experimental and clinical evidence on the role of gluten/wheat in IBS; how to diagnose patients with functional symptoms attributable to gluten/wheat sensitivity; the importance of double-blind placebo controlled cross-over trials as confirmatory assays of gluten/wheat sensitivity; and finally, dietary measures for gluten/wheat sensitive patients. The analysis of current evidence proposes that gluten/wheat sensitivity can indeed represent a subset of the broad spectrum of patients with a clinical presentation of IBS. (J Neurogastroenterol Motil 2016;22:547-557)

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Section: Experimental Evidence For a Role Of Wheat Components In Irrimentioning

confidence: 99%

Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?

Volta

Sánchez

Boschetti

et al. 2016

J Neurogastroenterol Motil

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“…the cereal protein amylase-trypsin inhibitors (ATIs) [3] . Evidence is also accumulating on the possible role of so-called FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols) in the induction of NCGS-like intestinal manifestations, e.g.…”

Section: Introductionmentioning

confidence: 99%

Gluten Sensitivity

Catassi¹

2015

Ann Nutr Metab

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Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing food in subjects who are not affected by either celiac disease (CD) or wheat allergy (WA). The prevalence of NCGS is not clearly defined yet. Indirect evidence suggests that NCGS is slightly more common than CD, the latter affecting around 1% of the general population. NCGS has been mostly described in adults, particularly in females in the age group of 30-50 years; however, pediatric case series have also been reported. Since NCGS may be transient, gluten tolerance needs to be reassessed over time in patients with NCGS. NCGS is characterized by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal, and relapse following gluten challenge within hours/days. The ‘classical' presentation of NCGS is a combination of irritable bowel syndrome-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as ‘foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia. In recent years, several studies explored the relationship between the ingestion of gluten-containing food and the appearance of neurological and psychiatric disorders/symptoms like ataxia, peripheral neuropathy, schizophrenia, autism, depression, anxiety, and hallucinations (so-called gluten psychosis). The diagnosis of NCGS should be considered in patients with persistent intestinal and/or extraintestinal complaints showing a normal result of the CD and WA serological markers on a gluten-containing diet, usually reporting worsening of symptoms after eating gluten-rich food. NCGS should not be an exclusion diagnosis only. Unfortunately, no biomarker is sensitive and specific enough for diagnostic purposes; therefore, the diagnosis of NCGS is currently based on establishing a clear-cut cause-effect relationship between the ingestion of gluten and the appearance of symptoms by a standardized double-blind, placebo-controlled gluten challenge.

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“…They are also present in rye and barley, are considered triggers of Non-Celiac Wheat/ Gluten sensitivity [9,10]. They are present in commercial gluten, resist proteolytic digestion and induce innate immune response resulting in monocytes, macrophages, and dendritic cells activation of the Toll Like receptor (TLR4 complex).…”

Section: Atis (Amylase Trypsin Inhibitors)mentioning

confidence: 99%