Trinity scientists are learning about a wide range of diseases by studying coeliac disorder, writes Dick Ahlstrom
An intensive study of coeliac disease is revealing much about many other common human diseases. It is a useful "prototype" for a range of disorders from rheumatoid arthritis to Crohn's disease.
People with coeliac disease must avoid the gluten found in wheat-based products, and the health problems it causes are easily avoided if this advice is followed.
It is one of the few inflammatory diseases whose trigger is well known and understood, explains Prof Con Feighery of Trinity College Dublin. It therefore provides a model that can reveal much about other similar disorders. "The reason we look at coeliac disease is that in some ways it is a prototype immune system disease," says Prof Feighery, professor of immunology at Trinity College and consultant in clinical immunology at St James's Hospital Dublin. "It is a very good model for auto-immune disease. I think it has a lot to teach us."
Prof Feighery has spent decades studying the immune system, and last May received the annual public lecture award given by the Irish Society of Immunology.
Better diagnosis of coeliac disease has caused incidence levels to rocket in recent years. Doctors used to expect to see one case per 1,000 to 5,000, but now the case load is one per 100 to 200 people.
"Coeliac disease is a condition where you develop inflammation of the intestine in people who are sensitive to gluten. The patient develops inflammation and this results in damage to the intestine and in turn causes mal absorption," says Prof Feighery.
While most people can easily control the inflammation by avoiding gluten, a fraction of patients experience ongoing damage caused by the body's own inappropriate immune response.
Prof Feighery and his colleagues are studying this in exacting detail, looking at the minute biochemical responses seen at the cellular level. There are genes central to the proper response of our immune system to invading bacteria and viruses and many of these genes are associated with the development of coeliac disease, he explains.
Initial exposure to gluten causes the immune system to change permanently. "The cell that seems to be central in coeliac disease is the T-cell. It is the products produced by the T-cell that cause the damage in coeliac disease." The T-cell releases signalling chemicals known as cytokines. Feighery uses a technique known as flow cytometry to look at the surface of individual cells looking for cytokines on the surface and inside the cell. These reactions are compared in cell samples from patients with the disease and from healthy controls.
He describes the work as translational research - basic scientific research in the lab that has the potential to move quickly into a clinical setting and provide better treatments for the patient. "The thing we are trying to do is take the information we have available from our experimental work and put it to use with patients."
The work is also helping to explain what is seen in other auto-immune diseases. "This is a model disease where uniquely we already know what starts the inflammatory response. We have lots and lots to learn about auto-immune disease. Coeliac disease allows us to use it as a model for all auto-immune disease," he states.