Wheat Gluten and Coeliac Disease

The relationship between the development of symptoms of coeliac disease and the feeding of wheat flour was first established by Dicke (1950) in Holland. Dicke, Weijers and van de Kamer (1953) confirmed this association by feeding experiments using a quantitative biochemical method in the form of a long-term fat balance to determine the appear-ance and disappearance of steatorrhoea. Anderson, Frazer, French, Gerrard, Sammons and Smellie (1952), working independently, also demonstrated this correlation and confirmed that gluten or the protein fraction of wheat flour was the deleterious agent causing symptoms and steatorrhoea. The symptomatology of coeliac disease is largely dependent on inadequate absorption of foodstuffs which occurs when gluten is included in the diet and wheat and rye flour proteins are the only cereal proteins which have been shown conclusively to induce this malabsorption. Several groups of workers have investigated the possible mechanism by which gluten acts deleteriously. The following hypotheses have been suggested and examined: first, 'the allergic hypothesis ' or sensitivity of these patients to wheat gluten, and secondly, the 'enzyme hypothesis ' or alteration in the ability of these patients to digest and absorb gluten. Wheat and rye gluten are different from other cereal proteins in their chemical and physicochemical constitution in that they contain more glutamic acid and proline and can form a type of gel which enables them to be used in breadmaking. Little is known of the chain structure of the gluten molecule and the particular arrangement of peptides in the molecule, but the peptide pattern is probably associated with the gel property. A difference in peptide structure of wheat and rye gluten, together with a difference in the extra- or intracellular enzyme pattern of the coeliac patient might therefore be responsible for the development of symptoms in this disease. This paper presents some investigations to test these hypotheses and critically assesses other work in this field and makes suggestions concerning future experimental approaches. Although no definite conclusions are drawn it is felt that a record of these investigations will avoid repetition by others or stimulate further ideas.