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Clinical and Developmental Immunology
Volume 2012, Article ID 329150, 10 pages
Clinical Study

Reintroduction of Gluten Following Flour Transamidation in Adult Celiac Patients: A Randomized, Controlled Clinical Study

1Institute of Food Sciences, CNR, 83100 Avellino, Italy
2Center for Coeliac Disease S. Maria dell'Olmo Hospital, 84013 Cava de' Tirreni Salerno, Italy
3Gastroenterology Department, San G. Moscati Hospital, 83100 Avellino, Italy
4IPALC Research & Development, 83040 Frigento, AV, Italy

Received 10 April 2012; Accepted 28 May 2012

Academic Editor: Francisco J. Pérez-Cano

Copyright © 2012 Giuseppe Mazzarella et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A lifelong gluten-free diet (GFD) is mandatory for celiac disease (CD) but has poor compliance, justifying novel strategies. We found that wheat flour transamidation inhibited IFN-γ secretion by intestinal T cells from CD patients. Herein, the primary endpoint was to evaluate the ability of transamidated gluten to maintain GFD CD patients in clinical remission. Secondary endpoints were efficacy in prevention of the inflammatory response and safety at the kidney level, where reaction products are metabolized. In a randomized single blinded, controlled 90-day trial, 47 GFD CD patients received 3.7 g/day of gluten from nontransamidated (12) or transamidated (35) flour. On day 15, 75% and 37% of patients in the control and experimental groups, respectively, showed clinical relapse ( 𝑃 = 0 . 0 4 ) whereas intestinal permeability was mainly altered in the control group (50% versus 20%, 𝑃 = 0 . 0 6 ). On day 90, 0 controls and 14 patients in the experimental group completed the challenge with no variation of antitransglutaminase IgA ( 𝑃 = 0 . 6 3 ), Marsh-Oberhuber grading ( 𝑃 = 0 . 0 8 ), or intestinal IFN-γ mRNA ( 𝑃 > 0 . 0 5 ). Creatinine clearance did not vary after 90 days of treatment ( 𝑃 = 0 . 4 6 ). In conclusion, transamidated gluten reduced the number of clinical relapses in challenged patients with no changes of baseline values for serological/mucosal CD markers and an unaltered kidney function.