- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05644795
Wheat-free Diet in the Treatment of Sjogren's Syndrome
Efficacy of a Wheat-free Diet in Autoimmune Diseases: a Pilot Therapeutic Study in Sjogren's Disease
Study Overview
Status
Conditions
Detailed Description
In recent years, the existence of a wheat-related disorder, in patients who do not suffer from celiac disease (CD) or wheat allergy (WA), has been definitively ascertained and defined as non-celiac wheat sensitivity (NCWS). Its prevalence in the general population is unknown but self-reported NCWS is around 10%. Conflicting data have been reported about the underlying physiopathology. It has been known for years how exposure to gliadin, both in CD and in healthy patients (albeit with reduced levels in the latter), is able to alter intestinal permeability acting on zonulin release and signalling mechanisms. More recently, it has been shown that wheat has high concentrations of wheat amylase-trypsin inhibitors (ATIs), proteins able to activate innate immunity via toll-like receptor-4 (TLR-4) on myeloid cells. Orally ingested ATIs increase intestinal inflammation by activating gut and mesenteric lymphnode myeloid cells.
An increasing number of data have shown that patients with NCWS could have an association with autoimmune diseases, including thyroiditis, undifferentiated connective tissue disease, psoriatic arthritis, spondylarthritis, and Sjogren's syndrome (SS).
SS is an autoimmune disease characterized by an infiltrate of mononuclear cells, mainly lymphocytes, in the exocrine glands, especially the salivary and lacrimal glands. Some preliminary data suggested that a GFD can reduce sialadenitis and increase salivary flow in SS and CD patients. Furthermore, some SS patients have an inflammatory response (release of nitric oxide) to a rectal gluten challenge.
Based on these evidences, as well as on the ability of gluten/wheat to increase intestinal permeability, altering zonulin mechanisms of regulation and signalling, and the ability of some of its components (ATIs, but not only) to activate a local inflammatory response, it could be hypothesized that gluten/wheat may represents one of the pathogenetic environmental factors of SS and that its intake may be able to worsen symptoms in affected patients. In our hypothesis, exposure to gluten/wheat would cause a release of zonulin, which, binding to the surface of the intestinal epithelial cells, is able to modify cell cytoskeleton and to cause the loss of normal occludins function, ultimately leading to an increased monolayer permeability. This increase in permeability would result in greater exposure of the immune system cells to gluten/wheat molecules via activation of TLR-4, with an increase in the infiltration and activation of myeloid cells in the intestinal mucosa and an augmented activity of lymphnode dendritic cells. Such local inflammatory response would have systemic repercussions with alteration of normal cytokine pattern and infiltration of monocytes/macrophages and T cells in the salivary and lacrimal glands, thus being able to contribute, as an environmental factor, to the onset and exacerbation of the clinical manifestations of SS.
Therefore, the investigators hypothesize that a wheat-free diet (WFD) can reduce the inflammatory state and ameliorate the clinical symptoms in SS patients. This hypothesis will be evaluated in both SS patients with associate GI symptoms and in those without GI symptoms. The successive clinical and immunologic reaction to the re-exposure to wheat ingestion, performed by an open challenge, will be also evaluated to confirm a wheat-dependent mechanism and to understand the underlining mechanisms. The project results will provide data about a possible therapeutic role of a WFD in SS and will improve the knowledges about the axis between the intestinal permeability and the systemic inflammation in SS.
More specifically, the investigators aim to:
- identify the prevalence of self-reported NCWS in SS patients;
- assess the overall effect that a WFD plus cow's milk products free diet (CMPFD) determines in symptoms control of the patients affected with SS; the investigators decided to include a CMPFD in association with a WFD because, according to several authors, including our previous studies, NCWS, and more generally gluten-related disorders, are often associated with multiple foods intolerance, first of all cow's milk products intolerance;
- evaluate, by an open wheat challenge, the real frequency of a coexistent NCWS condition;
- assess the possible role played by wheat ingestion in the pathogenesis and molecular mechanisms of SS and NCWS by analysing the variation of intestinal permeability and gut microbiota, in association with cytokines and lymphocytes pattern typical of SS.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Pasquale Mansueto, MD
- Phone Number: +393477279879
- Email: pasquale.mansueto@unipa.it
Study Contact Backup
- Name: Aurelio Seidita, MD
- Phone Number: +393209150370
- Email: aurelio.seidita@unipa.it
Study Locations
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-
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Palermo, Italy, 90127
- Recruiting
- Internal Medicine Department of the University Hospital of Palermo
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Contact:
- Pasquale Mansueto, MD
- Phone Number: +39-091-6552884
- Email: pasquale.mansueto@unipa.it
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Principal Investigator:
- Pasquale Mansueto, MD
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-
PA
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Palermo, PA, Italy, 90146
- Recruiting
- Internal Medicine Division of the "Cervello-Villa Sofia" Hospital
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Contact:
- Antonio Carroccio, MD
- Phone Number: +390916554815
- Email: acarroccio@hotmail.com
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Palermo, PA, Italy, 90127
- Recruiting
- Rheumatology Department of the University Hospital of Palermo
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Contact:
- Giuliana Guggino, MD
- Email: giuliana.guggino@unipa.it
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Contact:
- Giulia Grasso, MD
- Email: giulia.grasso@unipa.it
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Sub-Investigator:
- Lidia La Barbera, md
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
The study will be a prospective, randomized, placebo-controlled, single center clinical trials. Patients diagnosed with SS, fulfilling the American-European Consensus Group criteria for SS, will be recruited at the outpatient clinic of the Rheumatology Department, University Hospital 'P. Giaccone' of Palermo, Italy.
Inclusion criteria of SS patients
- age >18 and <65 years;
- negativity of anti-deamidated gliadin protein (anti-DGP) immunoglobulins (Ig) class A (IgA) and immunoglobulins (Ig)G, anti-tissue transglutaminase (anti-tTG) class IgA and IgG, and Endomysium antibodies (EmA);
- absence of intestinal villous atrophy, documented in all the patients carrying the DQ2 and/or the DQ8 Human Leukocyte Antigen (HLA) haplotypes (thus irrespective of CD-specific serum antibody negativity
- absence of WA (negative prick-test and/or specific serum immunoglobulin (Ig) E assay for wheat, gluten, and gliadin).
Exclusion criteria of SS patients
- age <18 and >65 years;
- self-exclusion of gluten/wheat from the diet and refusal to reintroduce it, for diagnostic purposes, before entering the study;
- pregnancy;
- alcohol and/or drug abuse;
- Helicobacter pylori and other bacterial and/or parasitic infections;
- diagnosis of chronic inflammatory bowel disease and other organic pathology affecting the digestive system (e.g., severe liver disease), nervous system diseases, major psychiatric disorders, immunological deficits, and impairments that limit physical activity;
- diagnosis of cancer
- patients undergoing chemotherapy and/or radiotherapy.
Study design In a preliminary phase of the study, all patients who access the SS outpatient clinic of the Rheumatology Department of the University Hospital 'P. Giaccone' of Palermo, Italy, will be asked to answer, consecutively, to a questionnaire for the self-assessment of wheat and other foods' intolerance.
After this evaluation, individual's enrollment will start. A database will be predisposed to register demographic, clinical, laboratory, cytofluorimetric and immunohistochemistry data. A repository bank will be used to collect samples from patients at different timepoints.
Patients enrolled based on the inclusion and exclusion criteria and who have agreed to enter the study, after having signed the informed consent, will be randomized, matched for age/gender/racial origin, through a computerized system into an intervention group and a control group. The two groups, each of 15 subjects, will be asked to follow a diet for 2 months. Intervention group will be asked to eliminate wheat and all cow's milk (both fresh and aged) products from the diet (i.e., WFD plus CMPFD). The control group will be asked to eliminate rice and turkey's meat products from the diet. The elimination diet in the control group must be considered as a 'placebo diet' because both rice and turkey's meat are foods known to be used in standard 'oligoantigenic' elimination diet.
Before starting the elimination diet (at time 0, T0), patients will be evaluated by experienced rheumatologists to assess their clinical features, as well as by physicians with expertise in the field of food intolerance about GI and extraintestinal symptoms which could be related to foods intake. Moreover, at this time point, all subjects will be subjected to:
- salivary flux study, by standard sialometry, and salivary samples collection (treated to block enzymatic digestion of proteins), to dose immunologic and inflammatory markers;
- a blood sample, for the analysis of inflammatory markers, cytokine profile, and intestinal permeability markers;
- a urine collection, after the administration of the lactulose/mannitol (LA/MA) test, to define intestinal permeability;
- a collection of stools, for calprotectin assay and definition of the gut microbiota;
- a dietary consult to better explain the dietary approach and provide any information useful to allow adherence to the elimination diet;
- finally, an alimentary (for the self-assessment of adherence to the diet) and symptom's diary will be provided to all patients, which must be filled-in daily.
After 2 months of elimination diet (at time 1, T1), intervention and control patients will be evaluated again both clinically and by laboratory techniques, repeating exactly what have been done at T0. Moreover, they will have to deliver alimentary and symptom's diary, and will discuss the results with physicians.
At this time-point, the subjects enrolled in the intervention group will go to an open challenge, with reintroduction of wheat. After 2 weeks of open diet or whenever rheumatologic, intestinal and/or extraintestinal symptoms should return or intensify (T2int), patients will be valued again both clinically and by laboratory techniques, repeating exactly what have been done at T0 and T1. Patients in this group will end the study at this time-point.
At the same timepoint, patients enrolled in the control group will be asked to repeat the elimination diet, this time removing from the diet wheat and all cow's milk (both fresh and aged) products (i.e., i.e., WFD plus CMPFD, in the context of a cross-over design), for further 2 months (T2con). At the end of these 2 months patients will be valued again both clinically and by laboratory techniques repeating exactly what have been done at T0 and T1. As described before for the intervention group, at this time-point patients of the control group will go to an open challenge with reintroduction of wheat. After 2 weeks of open diet or whenever rheumatologic, intestinal and/or extraintestinal symptoms should return or intensify (T3con), patients will be valued again both clinically and by laboratory techniques repeating exactly what have been done at T0, T1 and T2con. Patients in this group will end the study at this time-point.
Sample size The sample size is difficult to determine as no precise data are known about the effectiveness of a WFD and the response to wheat re-exposure after challenge in SS patients, as well as NCWS frequency in these subjects; previously reported data suggest that about 25% of NCWS patients suffer from an autoimmune disease, and in a study evaluating the effect of a GFD on quality of life, GI symptoms, and immune system in patients with fibromyalgia and NCWS, statistical significance was reached with 10 subjects. Other studies assessing NCWS immunological pattern obtained statistical significance with 26, 30, 22, and 12 patients. Therefore, considering the nature of this prospective and pilot study the investigators planned to enroll a total of 30 patients suffering from SS, 15 with GI symptoms and 15 without, fulfilling the American-European Consensus Group criteria for SS.
Definition of 'positivity' to the open challenge During the open challenge period, patients will be asked to note the possible onset of intestinal and/or extraintestinal symptoms using the food and symptom's diary, using a 10-point Visual Analogic Scale (VAS). The challenges will be stopped when a clinical reaction will occur for at least two consecutive days with a >3-point increase in the patient's recorded symptom VAS scale. The challenges will be considered positive if the same symptoms, which were initially present, will reappear after their disappearance on elimination diet and if the GSRS score and/or the extraintestinal symptoms rating scale will be 25% higher than the same score recorded on elimination diet. Finally, from a strictly rheumatologic point of view, the challenge will be considered positive if a 5% increase in the ESSPRI and ESSDAI score will be registered compared to the same score recorded on the elimination diet.
Statistical Analysis Statistical analysis will be performed using commercial software. Parametric and non-parametric statistical analysis will be performed calculating the mean ± standard deviation (SD) and median, respectively. For comparison of parametric and non-parametric data, the t-test and Mann-Whitney rank-sum test will be used where appropriate. Spearman's correlation analysis will be used to quantify the association between analysed variables. Data will be expressed as mean ± SD. P values less than 0.05 will be considered significant.
All subjects will agree to participate in the study. The study protocol will conform to the ethical guidelines of the Declaration of Helsinki, will be preliminary approved by the Human Research committee of the University Hospital of Palermo, Italy, and registered on the CliniaclTrials.gov. All authors will have access to the study data and will review and approve the final manuscript.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Active Comparator: wheat/milk free diet (W/MFD) group
Patients randomized to intervention group will go to a 2 months elimination diet (wheat and cow's milk products).
After 2 months of elimination diet they will go to an open challenge, with reintroduction of wheat.
After 2 weeks of open diet or whenever rheumatologic, intestinal and/or extraintestinal symptoms should return or intensify, patients will end the study.
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Patients randomized to intervention diet group will have to follow a wheat and cow's milk products free diet and, after 2 months, they will be exposed to an open wheat challenge, with reintroduction of wheat.
After 2 weeks of open diet, or whenever dermatologic, intestinal and/or extraintestinal symptoms should return or intensify, all patients will be revaluated and will end the study.
Other Names:
|
Placebo Comparator: Placebo Comparator: rice/turkey free diet (R/TFD) group
Patients randomized to control group will go to a 2 months elimination diet (rice and turkey's meat).
After 2 months of elimination diet they will crossover to a 2 months elimination diet (wheat and cow's milk products).
After 2 months of elimination diet they will go to an open challenge, with reintroduction of wheat.
After 2 weeks of open diet or whenever rheumatologic, intestinal and/or extraintestinal symptoms should return or intensify, patients will end the study.
|
Patients randomized to control diet group will have to follow a diet with elimination of rice and turkey's meat products for 2 months; after that they will crossover to a wheat and cow's milk products free diet and, finally, after 2 months, they will be exposed to an open wheat challenge, with reintroduction of wheat.
After 2 weeks of open diet, or whenever dermatologic, intestinal and/or extraintestinal symptoms should return or intensify, all patients will be revaluated and will end the study.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Self-perceived non-celiac wheat sensitivity (NCWS) questionnaire in SS patients
Time Frame: Before enter the study
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To identify SS patients reporting a self-perceived NCWS; all patients will be asked to answer, consecutively, to a validated questionnaire for the self-assessment of wheat and other foods' intolerance.
This is a questionnaire self-compiled by patients consisting of three sections: 1) general information (eg.
age, sex, highest completed education level, etc.) 2) wheat-related symptoms (sore 0 = no symptoms, score = 1, symptoms after wheat intake; if score = 1 other question qualitatively inquire the symptoms evoked by wheat intake, eg.
what kind of symptoms, how long patient perceive this problem, etc.); 3) other foods-related symptoms (score 0 = no symptoms, score 1 = symptoms after intake of other foods; if score = 1 other question qualitatively inquire the symptoms evoked by the intake of the specific food reported by the patients, eg.
what kind of symptoms, how long patient perceive this problem, etc.)
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Before enter the study
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Effect of WFD plus CMPFD in symptoms of SS patients as assessed by ESSPRI
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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To define effects induced by a WFD plus CMPFD in SS patient's symptoms.
The following score will be used: European League Against Rheumatism (EULAR) SS Patient Reported Index [ESSPRI, a self-evaluation index measuring symptoms, including pain, fatigue, and dryness, each symptom measured with a single 0, no symptoms, to 10, severe symptoms, scores <5 indicating low and >5 high disease activity).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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Effect of WFD plus CMPFD in symptoms of SS patients as assessed by ESSDAI
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1).
|
To define effects induced by a WFD plus CMPFD in SS patient's symptoms.
The following score will be used: EULAR SS Disease Activity Index (ESSDAI, a systemic disease activity index, consisting of 12 domains, 11 related to organ involvement and 1 biological domain, cut-off values of >5 and <14 defining moderate, and >14 severe systemic disease activity).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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Effect of WFD plus CMPFD in symptoms of SS patients as assessed by GSRS
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1).
|
To define effects induced by a WFD plus CMPFD in SS patient's symptoms.
The following score will be used: Gastrointestinal Symptom Rating Scale (GSRS), assessment scale for irritable bowel syndrome-like and functional dyspepsia-like symptoms, providing for a score ranging from 15 (no gastrointestinal symptoms) to 60 (uncontrolled gastrointestinal symptoms).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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Effect of WFD plus CMPFD in symptoms of SS patients as assessed by Extraintestinal symptoms rating scale.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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To define effects induced by a WFD plus CMPFD in SS patient's symptoms.
The following score will be used: Extraintestinal symptoms rating scale, a scoring system based on the symptoms most frequently observed in NCWS patients, providing for a score ranging from 9 (no extra intestinal symptoms) to 34 (uncontrolled extra intestinal symptoms).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1).
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effect of open wheat challenge in symptoms of SS patients as assessed by ESSPRI.
Time Frame: From T1 to 2 weeks of open wheat challenge (T2int and T3con).
|
To evaluate, by an open wheat challenge, the frequency of a coexistent NCWS condition in SS patients, both of the intervention group (T2int) and the control group (T3con).
The following score will be used: European League Against Rheumatism (EULAR) SS Patient Reported Index [ESSPRI, a self-evaluation index measuring symptoms, including pain, fatigue, and dryness, each symptom measured with a single 0, no symptoms, to 10, severe symptoms, scores <5 indicating low and >5 high disease activity).
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From T1 to 2 weeks of open wheat challenge (T2int and T3con).
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Effect of open wheat challenge in symptoms of SS patients as assessed by ESSDAI.
Time Frame: From T1 to 2 weeks of open wheat challenge (T2int and T3con).
|
To evaluate, by an open wheat challenge, the frequency of a coexistent NCWS condition in SS patients, both of the intervention group (T2int) and the control group (T3con).
The following score will be used: EULAR SS Disease Activity Index (ESSDAI, a systemic disease activity index, consisting of 12 domains, 11 related to organ involvement and 1 biological domain, cut-off values of >5 and <14 defining moderate, and >14 severe systemic disease activity).
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From T1 to 2 weeks of open wheat challenge (T2int and T3con).
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Effect of open wheat challenge in symptoms of SS patients as assessed by GSRS.
Time Frame: From T1 to 2 weeks of open wheat challenge (T2int and T3con).
|
To evaluate, by an open wheat challenge, the frequency of a coexistent NCWS condition in SS patients, both of the intervention group (T2int) and the control group (T3con).
Gastrointestinal Symptom Rating Scale (GSRS), assessment scale for irritable bowel syndrome-like and functional dyspepsia-like symptoms, providing for a score ranging from 15 (no gastrointestinal symptoms) to 60 (uncontrolled gastrointestinal symptoms).
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From T1 to 2 weeks of open wheat challenge (T2int and T3con).
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Effect of open wheat challenge in symptoms of SS patients as assessed by Extraintestinal symptoms rating scale.
Time Frame: From T1 to 2 weeks of open wheat challenge (T2int and T3con).
|
To evaluate, by an open wheat challenge, the frequency of a coexistent NCWS condition in SS patients, both of the intervention group (T2int) and the control group (T3con).
Extraintestinal symptoms rating scale, a scoring system based on the symptoms most frequently observed in NCWS patients, providing for a score ranging from 9 (no extra intestinal symptoms) to 34 (uncontrolled extra intestinal symptoms).
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From T1 to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary flux
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary flux (ml/min) will be studied by standard sialometry.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of immunoglobulin A
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess immunoglobulin A.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of immunoglobulin G
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess immunoglobulin G
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of lactoferrin
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess lactoferrin.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of beta 2-microglobulin
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess beta 2-microglobulin.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of IL-2
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess interleukin (IL)-2
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Salivary dosage of IL-6
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory salivary analysis will be performed to assess interleukin (IL)-6.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess ESR
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess erythrocyte sedimentation rate (ESR).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess CRP
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess C-reactive protein (CRP).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess RF.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess rheumatoid factor (RF).
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess C3
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess C3
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess C4.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess C4.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess complete blood count.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess complete blood count.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis in SS and NCWS patients to assess beta 2-microglobulin.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Laboratory blood analysis will be performed to assess beta 2-microglobulin.
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-6
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-10
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-17
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-18
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-21
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: IL-22
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: tumor necrosis factor (TNF)-alpha
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
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Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: interferon (IFN)-gamma,
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From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: B cell activating factor (BAF)
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of inflammatory cytokines in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of inflammatory cytokines pattern will be performed to assess: C-X-C Motif Chemokine Ligand 13 (CXCL13)
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: lymphocyte T helper (Th)1
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: lymphocyte T helper Th17
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: lymphocyte T helper Th22
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: lymphocyte T regulator (Treg)
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: follicular B helper T cells (Tfh)
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: innate lymphocyte cell (ILC)1
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: innate lymphocyte cell (ILC)2
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: innate lymphocyte cell (ILC)3
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: lymphocyte T cluster of differentiation (CD)8+
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: natural killer (NK) T cells
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern: B cells
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis to evaluate expression of lymphocytes typical of SS.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood cytofluorimetric analysis will be performed to assess expression of lymphocytes typical of SS pathogenetic pattern:interferon type I signature in cluster of differentiation (CD)14+ monocytes
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of intestinal permeability markers in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of intestinal permeability markers will be performed to assess: zonulin
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of intestinal permeability markers in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Peripheral blood ELISA analysis of intestinal permeability markers will be performed to assess: F-Actin
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
LA/MA test in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Lactulose/Mannitol (LA/MA) test will be performed to assess in vivo intestinal permeability.
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Fecal ELISA analysis of inflammatory gut marker in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Fecal ELISA analysis of inflammatory gut marker will be performed to assess fecal calprotectin.
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Gut microbiota assessment in SS and NCWS patients.
Time Frame: From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Gut microbiota assessment will be performed by quantification of gut microbiota on stools samples.
|
From the start of the study (T0) to 2 months of wheat elimination diet (T1), to 2 weeks of open wheat challenge (T2int and T3con).
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Chair: Antonio Carroccio, MD, University of Palermo
- Study Chair: Giuliana Guggino, MD, University of Palermo
Publications and helpful links
General Publications
- Carroccio A, Mansueto P, Iacono G, Soresi M, D'Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012 Dec;107(12):1898-906; quiz 1907. doi: 10.1038/ajg.2012.236. Epub 2012 Jul 24.
- Carroccio A, Rini G, Mansueto P. Non-celiac wheat sensitivity is a more appropriate label than non-celiac gluten sensitivity. Gastroenterology. 2014 Jan;146(1):320-1. doi: 10.1053/j.gastro.2013.08.061. Epub 2013 Nov 22. No abstract available.
- Carroccio A, Giambalvo O, Blasca F, Iacobucci R, D'Alcamo A, Mansueto P. Self-Reported Non-Celiac Wheat Sensitivity in High School Students: Demographic and Clinical Characteristics. Nutrients. 2017 Jul 19;9(7):771. doi: 10.3390/nu9070771.
- Fasano S, Mauro D, Macaluso F, Xiao F, Zhao Y, Lu L, Guggino G, Ciccia F. Pathogenesis of primary Sjogren's syndrome beyond B lymphocytes. Clin Exp Rheumatol. 2020 Jul-Aug;38 Suppl 126(4):315-323. Epub 2020 Oct 23.
- Rizzo C, Grasso G, Destro Castaniti GM, Ciccia F, Guggino G. Primary Sjogren Syndrome: Focus on Innate Immune Cells and Inflammation. Vaccines (Basel). 2020 Jun 3;8(2):272. doi: 10.3390/vaccines8020272.
- Rizzo C, La Barbera L, Lo Pizzo M, Ciccia F, Sireci G, Guggino G. Invariant NKT Cells and Rheumatic Disease: Focus on Primary Sjogren Syndrome. Int J Mol Sci. 2019 Oct 31;20(21):5435. doi: 10.3390/ijms20215435.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Immune System Diseases
- Autoimmune Diseases
- Eye Diseases
- Disease
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Connective Tissue Diseases
- Arthritis
- Stomatognathic Diseases
- Mouth Diseases
- Lacrimal Apparatus Diseases
- Arthritis, Rheumatoid
- Xerostomia
- Salivary Gland Diseases
- Dry Eye Syndromes
- Hypersensitivity
- Syndrome
- Sjogren's Syndrome
Other Study ID Numbers
- ACPM31
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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