Patologías relacionadas con el gluten: un auténtico desafío para la seguridad alimentaria.
DOI:
https://doi.org/10.12873/444garciaPalabras clave:
Celiac disease, Gluten-free dietResumen
El gluten se define como la fracción proteica obtenida en extractos etanólicos de granos de endospermos de cereales como trigo, cebada, centeno, espelta y kamut. Es ampliamente utilizado en la industria alimentaria, sin embargo, este componente puede causar reacciones adversas en personas sensibles.
Las patologías relacionadas con el gluten se dividen en tres grupos según su etiopatología. El primer grupo se corresponde con patologías de causa alérgica. El segundo incluye enfermedades de tipo autoinmune, dónde destaca la enfermedad celíaca, con una prevalencia global del 1 %. Esta patología se produce debido a la generación de anticuerpos dirigidos frente a péptidos deaminados de la gliadina (un componente del gluten transformado químicamente por enzimas intestinales) y a enzimas transglutaminasas endógenas. Esta respuesta inmune participa en la generación de un ambiente proinflamatorio que termina por destruir el tejido intestinal. Existe un tercer grupo de patologías, denominadas sensibilidad al gluten no celíaca, cuyo mecanismo molecular exacto es aún desconocido, pero se piensa que los componentes de la inmunidad innata participan de manera fundamental. Se han intentado desarrollar diversas alternativas para tratar estas patologías, pero ninguna ha demostrado un mejor coste-efectividad que la estricta adherencia a una dieta sin gluten. Esta dieta no sólo inhibe los síntomas, sino que estimula la regeneración del tejido intestinal, especialmente en niños. Para poder asegurar que estas personas puedan llevar a cabo una dieta libre de gluten, se ha desarrollado una legislación específica en diversos países.
En este artículo de revisión se abordan las patologías relacionadas con el gluten, su tratamiento, el marco legislativo internacional sobre el contenido en gluten en alimentos y las medidas que se aplican en la industria alimentaria para proteger a los pacientes sensibles a este compuesto.
Citas
Fasano A, Catassi C. Clinical practice. Celiac disease. New England Journal of Medicine. 2012;367(25):2419-26 DOI: 10.1056/NEJMcp1113994.
Goesaert H, Brijs K, Veraverbeke WS, Courtin CM, Gebruers K, Delcour JA. Wheat flour constituents: how they impact bread quality, and how to impact their functionality. Trends in Food Science & Technology. 2005;16(1-3):12-30 DOI: 10.1016/j.tifs.2004.02.011.
Martín M, Cacho JF, Cepeda A, Martín F, Prieto I. Informe del Comité Científico de la Agencia Española de Seguridad Alimentaria y Nutrición (AESAN) en relación con la enfermedad celíaca y los problemas que plantean las técnicas analíticas para el control del contenido de gluten en los alimentos. AESAN, 2010.
Shewry PR, Halford NG, Tatham AS, Popineau Y, Lafiandra D, Belton PS. The high molecular weight subunits of wheat glutenin and their role in determining wheat processing properties. Advances in Food and Nutrition Research. 2003;45:219-302 DOI: 10.1016/s1043-4526(03)45006-7.
Cebolla Á, Moreno M, Coto L, Sousa C. Gluten immunogenic peptides as standard for the evaluation of potential harmful prolamin content in food and human specimen. Nutrients. 2018;10(12):1927 DOI: 10.3390/nu10121927.
Wieser H. Chemistry of gluten proteins. Food Microbiology. 2007;24(2):115-9 DOI: 10.1016/j.fm.2006.07.004.
Shewry P. What is gluten—why is it special? Frontiers in Nutrition. 2019;6:101 DOI: 10.3389/fnut.2019.00101.
Ozuna CV, Iehisa JCM, Giménez MJ, Alvarez JB, Sousa C, Barro F. Diversification of the celiac disease α-gliadin complex in wheat: a 33-mer peptide with six overlapping epitopes, evolved following polyploidization. The Plant Journal. 2015;82(5):794-805 DOI: 10.1111/tpj.12851.
Schalk K, Lang C, Wieser H, Koehler P, Scherf KA. Quantitation of the immunodominant 33-mer peptide from α-gliadin in wheat flours by liquid chromatography tandem mass spectrometry. Scientific Reports. 2017;7(1):45092 DOI: 10.1038/srep45092.
Balakireva A, Zamyatnin A. Properties of gluten intolerance: gluten structure, evolution, pathogenicity and detoxification capabilities. Nutrients. 2016;8(10):644 DOI: 10.3390/nu8100644.
Matsuo H, Yokooji T, Taogoshi T. Common food allergens and their IgE-binding epitopes. Allergology International. 2015;64(4):332-43 DOI: 10.1016/j.alit.2015.06.009.
Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC Medicine. 2019;17(1):142 DOI: 10.1186/s12916-019-1380-z.
Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. 2012;10:13 DOI: 10.1186/1741-7015-10-13.
Palomares O, Akdis M, Martín-Fontecha M, Akdis CA. Mechanisms of immune regulation in allergic diseases: the role of regulatory T and B cells. Immunological Reviews. 2017;278(1):219-36 DOI: 10.1111/imr.12555.
Annunziato F, Romagnani C, Romagnani S. The 3 major types of innate and adaptive cell-mediated effector immunity. Journal of Allergy and Clinical Immunology. 2015;135(3):626-35 DOI: 10.1016/j.jaci.2014.11.001.
Al Badri FM, Baatjies R, Jeebhay MF. Assessing the health impact of interventions for baker’s allergy and asthma in supermarket bakeries: a group randomised trial. International Archives of Occupational and Environmental Health. 2020;93(5):589-99 DOI: 10.1007/s00420-019-01511-7.
Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, et al. Pathogenesis of celiac disease and other gluten related disorders in wheat and strategies for mitigating them. Frontiers in Nutrition. 2020;7 DOI: 10.3389/fnut.2020.00006.
Cianferoni A. Wheat allergy: diagnosis and management. Journal of Asthma and Allergy. 2016:13 DOI: 10.2147/jaa.s81550.
Gao X, Wen L, Li H, Wang R, Yin J. Genetic variation at the interleukin-18 locus is associated with wheat-dependent exercise-induced anaphylaxis in the Han Chinese population. Gene. 2020;737:144462 DOI: 10.1016/j.gene.2020.144462.
Hollon J, Puppa E, Greenwald B, Goldberg E, Guerrerio A, Fasano A. Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients. 2015;7(3):1565-76 DOI: 10.3390/nu7031565.
Kim SM, Mayassi T, Jabri B. Innate immunity: Actuating the gears of celiac disease pathogenesis. Best Practice & Research Clinical Gastroenterology. 2015;29(3):425-35 DOI: 10.1016/j.bpg.2015.05.001.
Stamnaes J, Sollid LM. Celiac disease: Autoimmunity in response to food antigen. Seminars in Immunology. 2015;27(5):343-52 DOI: 10.1016/j.smim.2015.11.001.
Pagliari D, Urgesi R, Frosali S, Riccioni ME, Newton EE, Landolfi R, et al. The interaction among microbiota, immunity, and genetic and dietary factors is the condicio sine qua non celiac disease can develop. Journal of Immunology Research. 2015;2015:1-10 DOI: 10.1155/2015/123653.
Schumann M, Richter JF, Wedell I, Moos V, Zimmermann-Kordmann M, Schneider T, et al. Mechanisms of epithelial translocation of the alpha(2)-gliadin-33mer in coeliac sprue. Gut. 2008;57(6):747-54 DOI: 10.1136/gut.2007.136366.
Hadjivassiliou M, Sanders DS, Woodroofe N, Williamson C, Grünewald RA. Gluten ataxia. The Cerebellum. 2008;7(3):494-8 DOI: 10.1007/s12311-008-0052-x.
Salmi TT. Dermatitis herpetiformis. Clinical and experimental dermatology. 2019;44(7):728-31 DOI: 10.1111/ced.13992.
Muddasani S, Rusk AM, Baquerizo Nole KL. Gluten and skin disease beyond dermatitis herpetiformis: a review. International Journal of Dermatology. 2021;60(3):281-8 DOI: 10.1111/ijd.15098.
Volta U, De Giorgio R, Caio G, Uhde M, Manfredini R, Alaedini A. Nonceliac wheat sensitivity: an immune-mediated condition with systemic manifestations. Gastroenterology Clinics of North America. 2019;48(1):165-82 DOI: 10.1016/j.gtc.2018.09.012.
Roszkowska A, Pawlicka M, Mroczek A, Bałabuszek K, Nieradko-Iwanicka B. Non-Celiac gluten sensitivity: a review. Medicina. 2019;55(6):222 DOI: 10.3390/medicina55060222.
Biesiekierski JR. What is gluten? Journal of Gastroenterology and Hepatology. 2017;32:78-81 DOI: 10.1111/jgh.13703.
Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno experts’ criteria. Nutrients. 2015;7(6):4966-77 DOI: 10.3390/nu7064966.
Tack GJ, van de Water JM, Bruins MJ, Kooy-Winkelaar EM, van Bergen J, Bonnet P, et al. Consumption of gluten with gluten-degrading enzyme by celiac patients: a pilot-study. World Journal of Gastroenterology. 2013;19(35):5837-47 DOI: 10.3748/wjg.v19.i35.5837.
McCarville JL, Nisemblat Y, Galipeau HJ, Jury J, Tabakman R, Cohen A, et al. BL-7010 demonstrates specific binding to gliadin and reduces gluten-associated pathology in a chronic mouse model of gliadin sensitivity. PLoS ONE. 2014;9(11):e109972 DOI: 10.1371/journal.pone.0109972.
Gujral N, Suh JW, Sunwoo HH. Effect of anti-gliadin IgY antibody on epithelial intestinal integrity and inflammatory response induced by gliadin. BMC Immunology. 2015;16(1) DOI: 10.1186/s12865-015-0104-1.
Leffler DA, Kelly CP, Green PHR, Fedorak RN, Dimarino A, Perrow W, et al. Larazotide Acetate for Persistent Symptoms of Celiac Disease Despite a Gluten-Free Diet: A randomized controlled trial. Gastroenterology. 2015;148(7):1311-9.e6 DOI: 10.1053/j.gastro.2015.02.008.
Rauhavirta T, Oittinen M, Kivistö R, Männistö PT, Garcia-Horsman JA, Wang Z, et al. Are Transglutaminase 2 Inhibitors able to reduce gliadin-induced toxicity related to celiac disease? a proof-of-concept study. Journal of Clinical Immunology. 2013;33(1):134-42 DOI: 10.1007/s10875-012-9745-5.
Kurada S, Yadav A, Leffler DA. Current and novel therapeutic strategies in celiac disease. Expert Review in Clinical Pharmacology. 2016;9(9):1211-23 DOI: 10.1080/17512433.2016.1200463.
Chang MS, Minaya MT, Cheng J, Connor BA, Lewis SK, Green PHR. Double-Blind Randomized Controlled Trial of Rifaximin for Persistent Symptoms in Patients with Celiac Disease. Digestive Diseases and Sciences. 2011;56(10):2939-46 DOI: 10.1007/s10620-011-1719-6.
Smecuol E, Hwang HJ, Sugai E, Corso L, Cherñavsky AC, Bellavite FP, et al. Exploratory, randomized, double-blind, placebo-controlled study on the effects of Bifidobacterium infantis natren life start strain super strain in active celiac disease. Journal of Clinical Gastroenterology. 2013;47(2):139-47 DOI: 10.1097/MCG.0b013e31827759ac.
Aljada B, Zohni A, El-Matary W. The gluten-free diet for celiac disease and beyond. Nutrients. 2021;13(11):3993 DOI: 10.3390/nu13113993.
Niland B, Cash BD. Health benefits and adverse effects of a gluten-free diet in non-celiac disease patients. Gastroenterology and Hepatology. 2018;14(2):82-91.
Wahab PJ, Meijer JW, Mulder CJ. Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. American Journal of Clinical Pathology. 2002;118(3):459-63 DOI: 10.1309/evxt-851x-whlc-rlx9.
Rubio-Tapia A, Rahim MW, See JA, Lahr BD, Wu T-T, Murray JA. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. American Journal of Gastroenterology. 2010;105(6):1412-20 DOI: 10.1038/ajg.2010.10.
Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Inchingolo CD, Monardo E, et al. Endoscopic and histological findings in the duodenum of adults with celiac disease before and after changing to a gluten-free diet: a 2-year prospective study. Endoscopy. 2006;38(7):702-7 DOI: 10.1055/s-2006-925178.
Tursi A, Brandimarte G. The symptomatic and histologic response to a gluten-free diet in patients with borderline enteropathy. Journal of Clinical Gastroenterology. 2003;36(1):13-7 DOI: 10.1097/00004836-200301000-00006.
Day L, Augustin MA, Batey IL, Wrigley CW. Wheat-gluten uses and industry needs. Trends in Food Science & Technology. 2006;17(2):82-90 DOI: 10.1016/j.tifs.2005.10.003.
Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? Journal of Human Nutrition and Dietetics. 2005;18(3):163-9 DOI: 10.1111/j.1365-277x.2005.00607.x.
Scherf KA, Poms RE. Recent developments in analytical methods for tracing gluten. Journal of Cereal Science. 2016;67:112-22 DOI: 10.1016/j.jcs.2015.08.006.
Akiyama H, Imai T, Ebisawa M. Japan food allergen labeling regulation—history and evaluation. Elsevier; 2011. p. 139-71.
Directrices para el desarrollo de un sistema APPCC en el sector de la pastelería (2013). Comunidad de Madrid. https://www.comunidad.madrid/servicios/salud/appcc-empresa-alimentaria.
Descargas
Publicado
Cómo citar
Licencia
Derechos de autor 2024 Nutrición Clínica y Dietética Hospitalaria
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Los lectores pueden utilizar los textos publicados de acuerdo con la definición BOAI (Budapest Open Access Initiative)
