Clinical Testing of Gliadin Fractions in Coeliac Patients

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Abstract
Since the toxic fraction of cereal flour which damaged the small bowel mucosa of patients with celiac disease had not been fully defined in vivo, the effect of intraduodenal infusions of different doses of unfractionated gliadin and of .alpha.-, .beta.-, .gamma.- and .omega.-gliadin subfractions on the morphology of multiple jejunal biopsies taken from 2 patients with treated celiac disease was studied. A dose-response study with increasing quantities of unfractionated gliadin in 1 celiac patient showed that 1000 mg produced marked damage in serial jejunal biopsies taken 2-3 h after commencing infusion and that the changes had almost completely disappeared 72 h later. .alpha.-, .beta.-, .gamma.- and .omega.-Gliadin were prepared, checked for purity and investigated for toxicity in 2 celiac patients. After an intraduodenal challenge with 1000 mg of the 4 gliadin subfractions these were shown to have induced damage in the mucosa of jejunal biopsies taken 6 h later. These observations confirmed the results of studies in vitro, which suggested that not only .alpha.- but .beta.-, .gamma.- and .omega.-gliadin were enterotoxic in celiac disease.