Enterovirus as trigger of coeliac disease: nested case-control study within prospective birth cohort, 2019, Størdal et al

[Andy]

Abstract
Objective To determine whether infection with human enterovirus or adenovirus, both common intestinal viruses, predicts development of coeliac disease.

Design Case-control study nested within Norwegian birth cohort recruited between 2001 and 2007 and followed to September 2016.

Setting Norwegian population.

Participants Children carrying the HLA genotype DR4-DQ8/DR3-DQ2 conferring increased risk of coeliac disease.

Exposures Enterovirus and adenovirus detected using real time polymerase chain reaction in monthly stool samples from age 3 to 36 months.

Main outcome measure Coeliac disease diagnosed according to standard criteria. Coeliac disease antibodies were tested in blood samples taken at age 3, 6, 9, and 12 months and then annually. Adjusted odds ratios from mixed effects logistic regression model were used to assess the relation between viral infections before development of coeliac disease antibodies and coeliac disease.

Results Among 220 children, and after a mean of 9.9 (SD 1.6) years, 25 children were diagnosed as having coeliac disease after screening and were matched to two controls each. Enterovirus was found in 370 (17%) of 2135 samples and was significantly more frequent in samples collected before development of coeliac disease antibodies in cases than in controls (adjusted odds ratio 1.49, 95% confidence interval 1.07 to 2.06; P=0.02). The association was restricted to infections after introduction of gluten. High quantity samples (>100 000 copies/μL) (adjusted odds ratio 2.11, 1.24 to 3.60; P=0.01) and long lasting infections (>2 months) (2.16, 1.16 to 4.04; P=0.02) gave higher risk estimates. Both the commonly detected enterovirus species Enterovirus A and Enterovirus B were significantly associated with coeliac disease. The association was not found for infections during or after development of coeliac disease antibodies. Adenovirus was not associated with coeliac disease.

Conclusions In this longitudinal study, a higher frequency of enterovirus, but not adenovirus, during early childhood was associated with later coeliac disease. The finding adds new information on the role of viral infections in the aetiology of coeliac disease.

Open access at https://www.bmj.com/content/364/bmj.l231

 

[Hip]

I also found this recent paper on the discovery of probable enterovirus particles in the brainstem neurons of Parkinson's patients very interesting.

The study used an electron microscope to observe virus-like particles of diameter ~30 nm within the neurons — which is the diameter of enterovirus (enteroviruses are small viruses of only 30 nm in size, hence the name of the family enteroviruses belong to: picornavirus, pico meaning very small).

There are some electron microscope pictures of these virus-like particles in the paper.


I wish we could get some electron micrographs of the neurons of ME/CFS patients.

 

[inox]

NRK (norwegian national broadcaster) coverage - norwegian - google english.

- We have found that a combination of gluten and enterovirus infection in the infant age increases the risk of celiac disease, says senior researcher and senior physician Ketil Størdal.

- The enterovirus makes it easier to damage the mucous membranes of the intestine, which means that the protein in the gluten comes into contact with the immune system, says Størdal.

Not everyone who has the enterovirus develops celiac disease.One must first eat gluten for this reaction to occur, but most importantly, one must be hereditary vulnerable.

Norwegian Institute of Public Health - norwegian - google english.

• Nearly all children had enterovirus in the samples at least once. In total, 20 percent of the samples from children who later received celiac disease, had enterovirus, compared with 15 percent of the samples from those who did not get the disease.
• There were only infections that occurred in the period after the baby started eating food with gluten, which was associated with increased risk of celiac disease.Intestinal infections before the baby starts with solid food did not increase the risk.
• Prolonged or severe enterovirus infections were dual risk associations.
• One other stomach virus, adenovirus, showed no correlation with celiac disease.