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Protocol Details

The Role of Autoimmunity in Neurologic Complications of Celiac Disease

This study is currently recruiting participants.

Summary | Eligibility | Citations | Contacts

Summary

Number

08-N-0153

Sponsoring Institute

National Institute of Neurological Disorders and Stroke (NINDS)

Recruitment Detail

Type: Participants currently recruited/enrolled
Gender: Male & Female
Min Age: 18
Max Age: 100

Referral Letter Required

No

Population Exclusion(s)

Children

Special Instructions

Currently Not Provided

Keywords

Celiac Disease;
Ataxia;
Adults

Recruitment Keyword(s)

Celiac Disease;
Ataxia;
Health Volunteer;
HV

Condition(s)

Ataxia

Investigational Drug(s)

None

Investigational Device(s)

None

Intervention(s)

None

Supporting Site

National Institute of Neurological Disorders and Stroke

This study, done in collaboration with Cornell University in New York, will explore the potential role of the body's immune response to gluten in ataxia. Celiac disease is an autoimmune disorder that is triggered by the ingestion of wheat gluten and related proteins in genetically susceptible individuals. Some people with celiac disease also develop ataxia, which is a loss of muscle coordination, leading to imbalance. The cause of the associated ataxia is not well understood, but it is suspected to be related to the immune response towards gluten in these patients. Preliminary results indicate that antibodies in people with celiac disease can react with brain proteins, which might have a role in the associated neurologic deficits. The aim of this study is to characterize the immune response in the ataxia that is associated with celiac disease.

People 18 years of age and older with 1) ataxia and no celiac disease, 2) ataxia plus celiac disease and 3) matched healthy control subjects will be enrolled at the NIH. People with celiac disease only will be enrolled at Cornell University.

All participants have a blood sample drawn for various tests of immune function as well as genetic tests. Healthy volunteers also have a history and physical examination if they have not had one done at NIH in the past year. Some patients may require additional clinical evaluations for clinical or diagnostic reasons.

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Eligibility

INCLUSION CRITERIA:

We plan to evaluate serum and blood from patients with gluten sensitivity (including both biopsy-proven CD, and biopsy-negative cases with high anti-gliadin antibody titer) accompanied by cerebellar ataxia. Serum samples will be acquired prior to initiation of a gluten-free diet. Therefore, several inclusion criteria exist based on the study group:

INCLUSION CRITERIA FOR PATIENTS WITH CD PLUS CEREBELLAR ATAXIA:

-The patient meets criteria for CD based on the modified ESPGAN criteria

-The patient has ataxia with or without neuropathy based on clinical evaluation

-The patient is free from other neurological and psychiatric deficits

-All other known causes for ataxia have been ruled out through routine clinical evaluations

-The patient is at least 18 years old and is willing to participate in the protocol

-The patient is not taking medications that are commonly known to have immune modulating effects.

-The patient is not on a gluten free diet

INCLUSION CRITERIA FOR PATIENTS WITH HEREDITARY CEREBELLAR ATAXIA WITHOUT CD:

-The patient tested negative for serologic markers of CD (i.e. antigliadin, antireticulin, and antiendomysial antibody testing as performed under protocol 93-N-0202)

-The patient has ataxia on routine clinical examination and no other neurological or psychiatric problems

-The patient has a known autosomal dominant ataxia (i.e., SCA, DRPLA, Friedreich's ataxia, and etc).

INCLUSION CRITERIA FOR MATCHED-CONTROLS:

-They should not have CD and or ataxia based on clinical evaluation and history

-Serologic testing for antigliadin, antireticulin, and antiendomysial antibodies should reveal negative results

-They should be race and age-matched with patients with CD and the ataxia group.

-They should have no neurological or psychiatric conditions based on clinical evaluation and history

-They should not have any rheumatological or autoimmune conditions in them or in their first degree relatives.

-They should be at least 18 years of age and be able to provide consent for participation

-They should not be on any immune modulating medications.

Final diagnosis of CD will strictly follow the modified criteria of the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN) and recommendations of the recently held National Institutes of Health Consensus Development Conference on Celiac Disease. Assessment and diagnosis of cerebellar ataxia will be made by magnetic resonance imaging of the brain, clinical examination and genetic testing for spinocerebellar ataxias and Friedreich's ataxia. Additional routine testing will be done if necessary to exclude other causes.

Healthy and disease control groups will be evaluated for CD and for neurological deficits. Only symptom-free, antibody-negative individuals will be recruited into these control groups. Exclusion of neurological deficits and psychiatric illness in healthy and disease control subjects will be by history and neurological examination.

EXCLUSION CRITERIA:

For all groups, if other neurological and psychiatric diagnoses are present, the individual will not qualify to participate in this study.

EXCLUSION CRITERIA FOR ALL GROUPS:

-Subject is already on a gluten-restricted diet.

-Is taking known immune modulating therapy

-Have other neurological condition (except for neuropathy) or psychiatric condition

-Not willing to have blood drawn

-Is known to have immune dysfunction

-Being pregnant leads to numerous physiological changes. It is unclear if antibody characteristics are influenced by these changes.


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Citations:

Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005 Feb 15;142(4):289-98.

Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.

Tommasini A, Not T, Kiren V, Baldas V, Santon D, Trevisiol C, Berti I, Neri E, Gerarduzzi T, Bruno I, Lenhardt A, Zamuner E, Span� A, Crovella S, Martellossi S, Torre G, Sblattero D, Marzari R, Bradbury A, Tamburlini G, Ventura A. Mass screening for coeliac disease using antihuman transglutaminase antibody assay. Arch Dis Child. 2004 Jun;89(6):512-5.

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Contacts:

Principal Investigator

Referral Contact

For more information:

Mark Hallett, M.D.
National Institute of Neurological Disorders and Stroke (NINDS)
National Institutes of Health
Building 10
Room 7D37
10 Center Drive
Bethesda, Maryland 20892
(301) 496-9526
hallettm@ninds.nih.gov

Elaine P. Considine, R.N.
National Institute of Neurological Disorders and Stroke (NINDS)
National Institutes of Health
Building 10
Room 7D36
10 Center Drive
Bethesda, Maryland 20892
(301) 435-8518
considinee@ninds.nih.gov

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

prpl@mail.cc.nih.gov

Clinical Trials Number:

NCT00692861

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