Changes in Intestinal Permeability 4 Hours After Gluten Challenge

June 5, 2019 updated by: Joseph A. Murray, M.D., Mayo Clinic

The Innate Response to and Changes in Intestinal Permeability 4 Hours After a Gluten Challenge in Subjects With Celiac Disease and Non Celiac Gluten Sensitivity

This study evaluates why people with celiac disease and non-celiac gluten/wheat sensitivity develop rapid onset symptoms within hours of gluten exposure. Half of subjects will be given gluten and half will not.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

When a person with celiac disease is exposed to gluten, their immune system attacks their bowel and causes abdominal pain, bloating, and diarrhea. This process takes 24-72 hours to occur. Some people without celiac disease develop similar symptoms when they eat gluten or wheat. Doctors and scientists do not know what causes this sensitivity to gluten. People with celiac disease and non-celiac gluten sensitivity report symptoms within hours of being exposed to gluten. This study evaluates why this occurs by looking at changes in blood, urine, stool, and the bowel after being given gluten.

Study Type

Interventional

Enrollment (Actual)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Minnesota
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 70 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria for subjects with Celiac Disease:

  • Biopsy proven celiac disease diagnosed at least 2 years prior to recruitment
  • Attest to following a gluten free diet to the best of their ability
  • Quiescent symptoms on a gluten free diet
  • Negative tissue transglutaminase at time of recruitment (to be collected with baseline blood work)
  • A prior endoscopy with small bowel biopsies reviewed by a gastrointestinal pathologist revealing healing

Inclusion Criteria for subjects with Non-Celiac Gluten Sensitivity:

  • Meet diagnostic consensus criteria as defined by Ludvigsson et al in "The Oslo definitions for coeliac disease and related terms"
  • Attest to following a gluten free diet to the best of their ability
  • Quiescent symptoms on a gluten free diet
  • Prior negative evaluation for celiac disease (including tissue transglutaminase IgA with total IgA or small bowel biopsies)
  • If subjects have had a small bowel biopsies revealing increased intraepithelial lymphocytes (IELs), they will be reviewed as a separate subgroup

Inclusion Criteria for Normal Subjects:

  • No gastrointestinal diagnosis (reflux, eosinophilic esophagitis, inflammatory bowel disease, or irritable bowel syndrome)
  • No gastrointestinal symptoms (diarrhea, abdominal pain, nausea, vomiting, weight loss)
  • No family history of celiac disease
  • Will not be required to have a baseline biopsy

Exclusion Criteria:

  • Tobacco use
  • Symptomatic coronary disease
  • Active, severe pulmonary disease
  • Baseline oxygen requirement
  • Coagulopathy (INR>1.5)
  • Mastocytosis
  • Active H. pylori infection
  • Treated celiac disease with neutrophilia or eosinophilia secondary to infection
  • Diabetes (type 1 and type 2)
  • Crohn's disease or Ulcerative colitis
  • Microscopic colitis
  • Dermatitis herpetiformis
  • Gastroparesis
  • Pregnant women

Subjects exposed to the following medications during their respective time frames will be excluded:

  • NSAIDs (24 hours)
  • Leukotriene inhibitors (24 hours)
  • Mast cell stabilizers (24 hours)
  • Benzodiazepines (24 hours)
  • H2 blockers (2 days)
  • H1 blockers (7 days)
  • Steroids (systemic or topically active within gastrointestinal tract) (30 days)
  • Topical steroids (14 days)
  • Intermittent (up to once weekly) tranquilizer (trazodone, doxepin) use (7 days)
  • Chronic tricyclic antidepressant or tranquilizer use (trazodone, doxepin) Use of these medications will also be prohibited during the study duration (AAAAI and AAOA).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: OTHER
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: TRIPLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
ACTIVE_COMPARATOR: Normal Subjects, Gluten Drink
Normal subjects will drink a solution containing 6 grams of gluten one time.
Dietary supplement: Gluten
Six grams of gluten will be mixed with water and Tang flavoring. Subjects will drink the mixture one time.
PLACEBO_COMPARATOR: Normal Subjects, Placebo Drink
Normal subjects will drink a solution without gluten one time.
Dietary supplement: Placebo
Subjects will drink a mixture of rice water and Tang flavoring one time.
ACTIVE_COMPARATOR: Celiac Subjects, Gluten Drink
Subjects with celiac disease will drink a solution containing 6 grams of gluten one time.
Dietary supplement: Gluten
Six grams of gluten will be mixed with water and Tang flavoring. Subjects will drink the mixture one time.
PLACEBO_COMPARATOR: Celiac Subjects, Placebo Drink
Subjects with celiac disease will drink a solution without gluten one time.
Dietary supplement: Placebo
Subjects will drink a mixture of rice water and Tang flavoring one time.
ACTIVE_COMPARATOR: Gluten Sensitivity, Gluten Drink
Subjects with non-celiac gluten sensitivity will drink a solution containing 6 grams of gluten one time.
Dietary supplement: Gluten
Six grams of gluten will be mixed with water and Tang flavoring. Subjects will drink the mixture one time.
PLACEBO_COMPARATOR: Gluten Sensitivity, Placebo Drink
Subjects with non-celiac gluten sensitivity will drink a solution without gluten one time.
Dietary supplement: Placebo
Subjects will drink a mixture of rice water and Tang flavoring one time.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Activation of the Mucosal Innate Immune System after Oral Gluten Challenge
Time Frame: 4 hours
Small bowel biopsies will be assessed for markers of innate immune system activation: presence of granulocytes, granulocyte degranulation, products of degranulation, interleukins and cytokines involved in the innate immune system response, inflammatory mediators.
4 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in Mucosal Permeability after Oral Gluten Challenge
Time Frame: Baseline and up to eight hours after gluten or placebo exposure
Mucosal permeability will be measure before and after oral gluten or placebo challenge with C13-mannitol lactulose urinary excretion testing. In addition, mucosal permeability will also be measured along the duodenum with a mucosal impedance probe.
Baseline and up to eight hours after gluten or placebo exposure
Detection of Gluten Peptides in Urine and Stool
Time Frame: Baseline and up to 72 hours after gluten or placebo exposure
Urine and stool samples will be assessed for the presence of gluten peptides. This will help assess how long these tests are positive after a known gluten exposure.
Baseline and up to 72 hours after gluten or placebo exposure
Rapid Onset Symptom Development after Gluten Exposure
Time Frame: Baseline and up to 72 hours after gluten or placebo exposure
Subjects will record the symptoms they experience after gluten or placebo exposure. The will complete a simple symptom diary every 30 minutes for the first 2 hours.
Baseline and up to 72 hours after gluten or placebo exposure

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mayo Clinic

Investigators

  • Principal Investigator: Joseph A. Murray, M.D., Mayo Clinic

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

October 10, 2017

Primary Completion (ACTUAL)

October 30, 2018

Study Completion (ACTUAL)

October 30, 2018

Study Registration Dates

First Submitted

September 18, 2017

First Submitted That Met QC Criteria

September 18, 2017

First Posted (ACTUAL)

September 20, 2017

Study Record Updates

Last Update Posted (ACTUAL)

June 7, 2019

Last Update Submitted That Met QC Criteria

June 5, 2019

Last Verified

June 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IRB 17-003596

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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