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. 2022 Jun;61(4):2033-2049.
doi: 10.1007/s00394-021-02765-z. Epub 2022 Jan 7.

Individual variability in patterns and dynamics of fecal gluten immunogenic peptides excretion after low gluten intake

Laura Coto  1   2 , Carolina Sousa  3 , Angel Cebolla  4
Affiliations

Individual variability in patterns and dynamics of fecal gluten immunogenic peptides excretion after low gluten intake

Laura Coto et al. Eur J Nutr. 2022 Jun.

Abstract

Purpose: Determination of Gluten Immunogenic Peptides (GIP) in feces is a direct tool for gluten exposure detection. The sensitivity of GIP detection methods for cases of unintentional low gluten intakes is unknown. We studied the interindividual variability in the kinetic of excretion under homogeneously controlled dietary conditions, and the sensitivity of fecal GIP tests after low amounts of punctual gluten ingestions.

Methods: Participants (n = 20) followed the same gluten-free menu for 12 days in which two separated doses of gluten (50 mg and 2 g) were ingested and all the depositions were collected. GIP from stool samples were analyzed by ELISA and lateral flow immunoassay (LFIA) tests.

Results: Most participants had detectable GIP after 50 mg and 2 g gluten ingestions using ELISA test (72.2% and 95%, respectively), whereas the LFIA test showed less sensitivity (22.2% and 80%, respectively). GIP were detected at higher either frequency or concentration in the range of 12-36 h after 50 mg intake, and 12-84 h after 2 g consumption. Considering this period, diagnostic sensitivity of GIP detection after a single 50 mg ingestion may be significatively increased analyzing three stool samples per individual. High variability among participants was found in the time and amount of GIP excretion; however, some individuals showed common patterns for both gluten intakes.

Conclusion: Sporadic gluten exposure detection may require several fecal samples to achieve level of sensitivity above 90%. Interindividual variability in the dynamic of GIP excretion may suggest patterns of gluten metabolism.

Keywords: Celiac disease; Gluten detection feces; Gluten immunogenic peptides; Gluten metabolism; Gluten-free diet monitoring.

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Conflict of interest statement

Angel Cebolla is the founder and current CEO of Biomedal S.L. (Seville, Spain), Angel Cebolla and Carolina Sousa are inventors of the patent “Detecting gluten peptides in human fluids” (no. WO/2016/005643), and Laura Coto is employee at Biomedal S.L.

Figures

Fig. 1
Fig. 1
Study timeline
Fig. 2
Fig. 2
Representation of gluten doses in a slice of bread. Dashed lines show the portion of the slice which represent 50 mg of gluten (a) and 2 g of gluten (b). The small piece of bread representing 50 mg of gluten is also compared in size to a AAA battery (a)
Fig. 3
Fig. 3
Flowchart showing distribution of the study participants
Fig. 4
Fig. 4
Qualitative results of fecal gluten immunogenic peptides (GIP) excretion after 50 mg of gluten intake using the ELISA. The trend of the GIP detection dynamics is represented by the dashed line
Fig. 5
Fig. 5
Qualitative results of fecal gluten immunogenic peptides (GIP) excretion after 50 mg of gluten intake using the lateral flow immunoassay. The trend of the GIP detection dynamics is represented by the dashed line
Fig. 6
Fig. 6
Qualitative results of fecal gluten immunogenic peptides (GIP) excretion after 2 g of gluten intake using the ELISA. The trend of the GIP detection dynamics is represented by the dashed line
Fig. 7
Fig. 7
Qualitative results of fecal gluten immunogenic peptides (GIP) excretion after 2 g of gluten intake using the lateral flow immunoassay. The trend of the GIP detection dynamics is represented by the dashed line
Fig. 8
Fig. 8
ELISA showing dynamics of fecal gluten immunogenic peptides (GIP) excretion following ingestion of 50 mg of gluten. Potential outliers are represented as dots
Fig. 9
Fig. 9
ELISA showing dynamics of fecal gluten immunogenic peptides (GIP) excretion following ingestion of 2 g of gluten. Potential outliers are represented as dots
Fig. 10
Fig. 10
Gluten immunogenic peptides (GIP) detected in fecal samples by ELISA between 12 and 84 h after gluten ingestion of 50 mg and 2 g of gluten
Fig. 11
Fig. 11
Individual variations in patterns of fecal gluten immunogenic peptides (GIP) excretion by ELISA. Peak of fecal GIP detection within 48 h after 50 mg (a) and 2 g (b) gluten ingestions, peak of fecal GIP detection from 48 h after 50 mg (c) and 2 g (d) gluten ingestions and increasing fecal GIP detection from 5 days after 2 g gluten ingestion (e)
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