Piatek-Guziewicz A, et al. - Physicians designed this study to assess selected intestinal parameters of oxidative stress, and antioxidant capacity in adult celiac disease (CD) patients with extraintestinal manifestations. Despite gluten-free diet (GFD), increased intestinal expression of heat-shock protein 70 (HSP-70) showed that GFD only partially reduced oxidative stress. An oxidative imbalance and inflammatory response was observed despite GFD, in CD patients. In CD, uric acid could act as an important antioxidant.

Methods

• The physicians recruited 85 adult patients in this study.
• Patients were divided into the following subgroups:
  • Patients with newly diagnosed celiac disease (CD) (n = 7);
  • Celiac patients not adhering to a gluten-free diet (GFD) (n = 22);
  • Patients with CD on the GFD (n = 31);
  • Patients with functional disorders of the gastrointestinal tract, serving as controls (n = 25).
• Non-classic symptoms or extraintestinal manifestations were noted in celiac patients.
• Standard blood tests were determined, including serum antioxidant levels (uric acid, bilirubin, and vitamin D), celiac antibody levels, and histopathological status of duodenal biopsy specimens.
• They analyzed the expression of mRNA for tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), interleukin 10 (IL-10), superoxide dismutase (SOD), heat-shock protein 70 (HSP-70), hypoxia-inducible factor 1 (HIF-1α), and BAX in the duodenal mucosa of patients by reverse transcriptase-polymerase chain reaction.

Results

• In patients with active CD (newly diagnosed and nonadherent patients) and treated celiac patients, the mean plasma uric acid level was significantly higher than in controls (260.17 ± 53.65 vs 190.8 ± 22.98, P < 0.001, and 261.7 ± 51.79 vs 190.8 ± 22.98, P < 0.001, respectively).
• In active and treated celiac patients, the mean bilirubin concentration was significantly lower than in controls (8.23 ± 5.04 vs 10.48 ± 4.08, P < 0.05 and 8.06 ± 3.31 vs 10.48 ± 4.08, P < 0.05, respectively).
• Among active celiac patients, the mean plasma vitamin D level was significantly lower than in treated celiac patients and controls (19.37 ± 9.03 vs 25.15 ± 11.2, P < 0.05 and 19.37 ± 9.03 vs 29.67 ± 5.12, P < 0.001, respectively).
• Regardless of the diet, the expression of TNF-α, IL-10, and HSP-70 mRNAs was significantly elevated in the celiac groups when compared with controls.
• A significantly lower mRNA expression of TNF-α and IL-10 was observed in patients on the GFD than in newly diagnosed and nonadherent patients (P < 0.05).
• In celiac patients, the expression of SOD mRNA was significantly elevated compared with controls (P < 0.05), with a significant difference between treated and untreated patients (P < 0.05).
• In patients with active CD, the expression of HIF-1α mRNA and BAX mRNA was significantly higher compared with controls and patients on GFD.
• No difference was observed between the latter 2 groups.