Probiotics as adjuvant therapy in coeliac disease?

At the occasion of the “New therapies in coeliac disease” conference hosted by Columbia University in New-York on March 20, 2014, Dr. Elena Verdú, our expert in Nutrition, is sharing with us the last trends in research in the field of Coeliac Disease (CeD), introducing the idea of a role of probiotics in the treatment of CeD.

Presence of intestinal dysbiosis has been demonstrated in two main categories of gastrointestinal disorders: functional, such as irritable bowel syndrome, and inflammatory bowel disease, including ulcerative colitis and Crohn’s disease, prompting fertile research into microbiota modulation in these disorders. In the past few years a new kid on the block, coeliac disease (CeD), has been added. CeD is a common chronic inflammatory condition of the small intestine caused by ingestion of gluten in genetically predisposed people.

At a recent meeting on the “Development of therapies for coeliac disease”, hosted in Columbia University, Dr. Julio Bai from the Hospital of Gastroenterology, Buenos Aires Argentina, indicated that, « patients with CeD have small intestinal microbial and fecal dysbiosis compared to healthy controls ». He also explained that after the gluten free diet, the only current available treatment for CeD, « only some of these changes are reversed ». Dr. Bai presented results from a clinical study in which supplementation with Bifidobacterium infantis reduced symptoms in patients with active CeD (See the following figure, Smecuol et al., J Clin Gastroenterol. 2013).

Celiac disease paper-Elena Verdu_230414

A follow up study in collaboration with with McMaster University demonstrated immunomodulatory effects of B. infantis in these patients, specifically in antimicrobial peptide expression in the small intestine (Smecuol et al., Gastroenterology (Suppl) 2013; 144:S894). Dr. Peter Green, director of the Coeliac Center at Columbia University highlighted that, « CeD is very common, affecting about 1% of the population. Current therapy is dietary, however, there is increasing interest in nutriceutical and pharmaceutical alternatives. Patients are very interested in these potential alternative (to the gluten-free diet) or adjunctive therapies, however further studies are necessary to determine if probiotics should be recommended for patients with CeD ».

Elena Verdú
Elena Verdú
Dr. Verdu’s research has focused on the pathophysiology of inflammatory and functional gastrointestinal disorders. She undertook clinical research training at the University of Lausanne, Switzerland, where she studied the interaction between chronic infection with Helicobacter pylori and gastritis in humans and the possible therapeutic role of probiotic bacteria. Her PhD studies in the Institute of Microbiology and Gnotobiology at the Czech Academy of Science and University of Lausanne focused on the effect of bacterial antigens in animal models of inflammatory bowel disease. As a post-doctoral fellow at McMaster University she gained experience with animal models of gut functional diseases and investigated the mechanisms of action of probiotic bacteria. As a member of the Farncombe Family Digestive Health Research Institute at McMaster University, Dr. Verdu investigates host-microbial and dietary interactions in the context of celiac disease, irritable bowel syndrome and inflammatory bowel disease. She has been honored with the New Investigator Award (Canadian Celiac Association), the New Investigator Award (Functional Gut-Brain Research Group, USA) and the Campbell Research Award in celiac disease (Canadian Celiac Association). The American Gastroenterology Association and the Canadian Association of Gastroenterology have awarded her the “Master’s in Gastroenterology Award” for basic science and “Young Investigator’s Award”, respectively. She is Associate Professor at the Division of Gastroenterology, Dep. of Medicine at McMaster University and currently directs the Axenic Gnotobiotic Unit at McMaster.