Coeliac disease affects 1 in 70 Australians, with the only treatment being a strict gluten-free diet. Major challenges for patients are the poor rates of diagnosis and a lifelong treatment that fails to resolve symptoms or enteropathy in a third of cases. Current diagnosis requires an invasive gastroscopy and active gluten consumption, which complicates precise diagnosis in the 15% of Australians who choose to eliminate dietary gluten prior to testing.
In order to tackle these clinical shortcomings, our research group has combined clinical and immune studies to characterise responses in patients following gluten consumption. We recently reported on a circulating cytokine cascade, primarily involving interleukin-2, induced by gluten that tracks with the frequency of pathogenic gluten-specific T cells and clinical symptoms. This cytokine response can be replicated in vitro using whole blood incubated with gluten peptides. We have now confirmed the assay is highly sensitive even in individuals that have removed gluten from their diet. Interestingly, in vitro IL-2 levels could also predict severe symptoms experienced by those with coeliac disease following a later gluten exposure. These findings are now being employed to advance immune-based diagnostics, improve gluten-free dietary guidelines, and facilitate the development of novel therapies.