Investigating the relationship between the immune system and coeliac disease; a greater understanding towards possible prevention strategies or new target areas for personal treatment

Professor Frits Koning is an immunologist with a special interest in gastrointestinal diseases.He was the director of the Dutch Coeliac Disease Consortium, from 2004 to 2014. In this consortium immunologists, medical doctors, geneticists and food experts have joined forces to understand the complex interactions leading to coeliac disease.

What was the main issue you wanted to address?

Put simply, the research aimed to understand how the two arms of the immune system are involved in coeliac disease. To explain in more detail, the immune system is complex and can make both adaptive and innate responses. Adaptive responses lead to immunological memory,which means that once a response has been made by a person’s immunesystem,they are then immune and respond stronger the next time they are exposed to the same pathogen (which can be bacteria or a virus that can cause illness). Of course, in people with coeliac disease the immune system mistakenly treats gluten as a pathogen, so the only treatment is a lifelong gluten free diet, to avoid reactivation of the memory response outlined above. The innate immune system is a first line of defence, and it is still unclear if andhow this is involved in coeliac disease. Improving our understanding of the immune system and gluten could potentially help people with coeliac disease in several ways: from finding targets for alternative treatments to even preventing the onset of the condition in the first place.

What are the key things you learned from this project?

Thanks to a new technique we were able to study the immune system in an entirely different way. We were hoping that this would reveal which components of the immune system derail when coeliac disease develops. The result is that we have obtained strong evidence that multiple components of the immune system are involved,from both the adaptive and innate parts.

The most important coeliac disease-associated changes in the immune system are found in intestinal biopsies (where some tissue from the small intestine is examined). These changes are found in both the adaptive and innate parts of the immune system. We also noticed changes to the immune system within patients’ blood samples and have gained new insight into the cell type involved in the development of refractory coeliac disease.

How will this project benefit people with coeliac disease?

The fact that we have found coeliac disease associated changes in blood samples could lead to the improvement of diagnosis procedures. And in the long run, a better understanding of how the immune system responds,can help us find out why coeliac disease patients respond to gluten in the way they do. This may even lead to finding out how to prevent this reaction in the future.