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Wheat is the most important staple food consumed in the Western world and provides beneficial health effects and functional properties. Nevertheless, an increasing proportion of the general population is avoiding or reducing its consumption of wheat products due to self-reported gastrointestinal (GI) symptoms, such as patients with non-coeliac wheat sensitivity (NCWS) and/or irritable bowel syndrome (IBS). There is increasing evidence that the amylase trypsin inhibitors (ATIs), accounting for up to 15% of wheat proteins, play a role in the symptom generation in NCWS and IBS. In vitro studies showed ATIs can induce an innate immune response via direct interaction with the toll-like receptor 4 (TLR4), activating the TLR4-MD2-CD14 complex with subsequent release of pro-inflammatory cytokines. These results were confirmed in mice. Furthermore, in mice ATIs triggered intestinal epithelial lymphocytosis and barrier dysfunction, and modified microbiota composition and metabolism. Thus far, there have been no placebo-controlled studies investigating these effects of isolated ATIs in human subjects. Understanding the role of ATIs in symptom generation in NCWS and IBS patients is important to provide these patients with appropriate dietary advice, improving their quality of life and decreasing their risk of nutritional deficiencies.
The investigators aim to perform a proof-of-concept study to assess the effect of ATIs on the intestinal barrier and immune function in healthy volunteers. The investigators hypothesise that the ATIs either directly affect the intestinal barrier function, or indirectly by activating an immune response via TLR4.
The study conforms a randomized, double-blind, placebo-controlled, cross-over design, using healthy human volunteers (male and female), 18-65 years old. Volunteers will each undergo two test days, separated by a wash-out period of at least 4 weeks. At the test day, volunteers receive either isolated ATIs or placebo (physiological saline), ingested using a nasogastric intraduodenal feeding catheter.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Amylase trypsin inhibitors (ATIs), then placebo | Experimental | Test day 1: intraduodenal administration of amylase trypsin inhibitors (ATIs) isolated from Triticum aestivum (bread wheat), dissolved in physiological saline. After a wash-out period of 4-6 weeks, test day 2: intraduodenal administration of placebo (physiological saline). |
|
| Placebo, then Amylase trypsin inhibitors | Experimental | Test day 1: intraduodenal administration of placebo (physiological saline). After a wash-out period of 4-6 weeks, test day 2: intraduodenal administration of amylase trypsin inhibitors (ATIs) isolated from Triticum aestivum (bread wheat), dissolved in physiological saline. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Amylase trypsin inhibitors | Other | Intraduodenal administration of amylase trypsin inhibitors (ATIs) isolated from Triticum aestivum (wheat), dissolved in physiological saline. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Difference in gene expression associated with intestinal barrier function, measured in duodenal biopsies collected after intervention with ATIs or placebo | Gene expression associated with intestinal barrier function, such as gene expression of tight junction and adherens junction proteins: e.g. peri-junctional Factin, myosin, ZO-1, claudin-3, occluding, myosin light chain kinase, phosphorylated myosin light chain, E-cadherin. Duodenal biopsies will be obtained using upper gastrointestinal endoscopy. | Biopsies will be collected 2 hours after administration of ATIs or placebo, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Difference in protein levels associated with intestinal barrier function, measured in duodenal biopsies collected after intervention with ATIs or placebo. | Expression of proteins associated with intestinal barrier function, such as tight junction and adherens junction proteins by Western blot and immunofluorescent staining. Duodenal biopsies will be obtained using upper gastrointestinal endoscopy. |
| Measure | Description | Time Frame |
|---|---|---|
| Participant characteristics | To assess suitability for participation of to characterise the study population, data will be collected on demographics and medical history using screening questionnaires. | Data on demographic factors and medical history will be collected during the screening visit |
| One-day food record to ensure dietary intake is similar during the 24 hours before testday 1 and testday 2. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marlijne CG de Graaf, MSc | Contact | +31(0)433884237 | m.degraaf@maastrichtuniversity.nl |
| Name | Affiliation | Role |
|---|---|---|
| Daisy MAE Jonkers, Prof, PhD | Maastricht University | Principal Investigator |
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| ID | Term |
|---|---|
| D043183 | Irritable Bowel Syndrome |
| ID | Term |
|---|---|
| D003109 | Colonic Diseases, Functional |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
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Randomized, double-blind, placebo-controlled, cross-over study
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| Placebo | Other | Intraduodenal administration of placebo (physiological saline). |
|
| Biopsies will be collected 2 hours after administration of ATIs or placebo, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Differences in gene expression associated with immune function, measured in duodenal biopsies collected after intervention with ATIs or placebo. | Gene expression associated with immune activation, such as TLR4, and pro-inflammatory cytokines and antimicrobiota peptides. Duodenal biopsies will be obtained using upper gastrointestinal endoscopy. | Biopsies will be collected 2 hours after administration of ATIs or placebo, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Differences in infiltration of immune cells in duodenal tissue, measured in duodenal biopsies collected after intervention with ATIs or placebo. | Infiltration of immune cells (neutrophils, mast cells, dendritic cells) into duodenal tissue by immunofluorescent staining. Duodenal biopsies will be obtained using upper gastrointestinal endoscopy. | Biopsies will be collected 2 hours after administration of ATIs or placebo, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Difference in change in gastrointestinal symptoms from baseline after intervention with ATIs or placebo. | Measured on the Visual Analogue Scale ranged from 0-100, in which 0 is absence of symptoms and 100 is severe symptoms; ATIs vs placebo | Various time points throughout each test day: 1 hour before and 5 minutes before intervention with ATIs or placebo, and 1 hour, 2 hours and 12 hours after intervention with ATIs or placebo |
| Difference in blood immune cell populations after intervention with ATIs or placebo | Quantification of immune cell populations (T helper cells, cytotoxic T cells, CD25+ effector T cells, CD69+ effector T cells, regulatory T cells, and NK-cells) in whole blood. | Blood samples will be collected directly after upper gastrointestinal endoscopy, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Difference in blood biomarkers of immune stimulation after intervention with ATIs or placebo | Measurement of biomarkers of immune stimulation (such as the human cytokines IL-10, TGF-β, IL-12p40 subunit, IL-12p70 subunit, IL-1β, IL-2, IL-6, IL-4, IL-17, IL-22 and IFN-γ, TNFα) in whole blood. | Blood samples will be collected directly after upper gastrointestinal endoscopy, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
| Blood markers for intestinal barrier function after intervention with ATIs or placebo | Markers for intestinal barrier function (plasma citrulin, metabolites) and small intestinal mucosal tissue injury (intestinal fatty acid binding protein (I-FABP)), measured in whole blood. | Blood samples will be collected directly after upper gastrointestinal endoscopy, on two separate test days. The test days are separated by a wash-out period of 4-6 weeks. |
Participants will be asked to repeat intake prior to testday 1 on the day prior to testday 2. Thus, the intake is written down during the 24 hours prior to test day 1, and repeated (and again written down) during the 24 hours prior to testday 1, which is 4-6 weeks after test day 1. |
| 24 hours prior to testday 1, and after a wash-out period of 4-6 weeks, also during the 24 hours prior to testday 2 |
| D004066 | Digestive System Diseases |