Patologías relacionadas con el gluten: un auténtico desafío para la seguridad alimentaria.

Eduardo Garcia-Calvo; Aina García-García; Santiago Rodríguez; Rosario Martín; Teresa García

doi:10.12873/444garcia

Autores/as

Eduardo Garcia-Calvo Departamento de Nutrición y Ciencia de los Alimentos. Universidad Complutense de Madrid
Aina García-García Departamento de Nutrición y Ciencia de los Aliemntos. Universidad Complutense de Madrid. https://orcid.org/0000-0003-1689-8751
Santiago Rodríguez Departamento de Nutrición y Ciencia de los Alimentos. Universidad Complutense de Madrid https://orcid.org/0000-0003-2185-1528
Rosario Martín Departamento de Nutrición y Ciencia de los Alimentos. Universidad Complutense de Madrid https://orcid.org/0000-0002-0091-8968
Teresa García Departamento de Nutrición y Ciencia de los Alimentos. Universidad Complutense de Madrid https://orcid.org/0000-0001-7387-0603

DOI:

https://doi.org/10.12873/444garcia

Palabras clave:

Celiac disease, Gluten-free diet

Resumen

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.

Referencias

Fasano A, Catassi C. Clinical practice. Celiac disease. New England Journal of Medicine. 2012;367(25):2419-26 DOI: 10.1056/NEJMcp1113994. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.3390/nu10121927

Wieser H. Chemistry of gluten proteins. Food Microbiology. 2007;24(2):115-9 DOI: 10.1016/j.fm.2006.07.004. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.3389/fnut.2020.00006

Cianferoni A. Wheat allergy: diagnosis and management. Journal of Asthma and Allergy. 2016:13 DOI: 10.2147/jaa.s81550. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1007/s12311-008-0052-x

Salmi TT. Dermatitis herpetiformis. Clinical and experimental dermatology. 2019;44(7):728-31 DOI: 10.1111/ced.13992. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.3390/medicina55060222

Biesiekierski JR. What is gluten? Journal of Gastroenterology and Hepatology. 2017;32:78-81 DOI: 10.1111/jgh.13703. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1016/B978-0-12-385989-1.00004-1

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.