How Does Adenovirus Affect Individuals With Coeliac Disease?

Overview

Coeliac disease is an autoimmune disorder that causes damage to the small intestine if gluten is ingested. Gluten is a protein found in wheat, oats, and barley which causes an immune response that damages the intestinal villi. As the disease is autoimmune, people with coeliac disease may be more prone to other infections. Coeliac disease affects approximately 1% of the population.¹ 

Adenoviruses are a group of viruses that can cause a range of illnesses from mild respiratory infections to severe gastroenteritis. In individuals with coeliac disease, the effect of adenovirus infection on their compromised immune system may pose challenges. 

In this article, we explore how adenovirus can affect individuals with coeliac disease.

What is coeliac disease?

Coeliac disease is an autoimmune disorder that causes damage to the small intestine when gluten is ingested. It occurs in around 1% of the population. 

Gluten is a protein found in wheat, oats and barley. Whilst gluten is a common and harmless part of the diet for most people, it causes an immune response that damages the intestinal villi in individuals with coeliac disease. This immune response leads to inflammation and damage to the villi in the small intestine which are vital for absorption of nutrients.  

The key aspect of coeliac disease management is a strict gluten-free diet.¹ 

Coeliac disease effects

Coeliac disease involves an immune response to eating gluten, the common protein in wheat, oats, and barley. In genetically predisposed individuals, gluten causes an immune response that triggers an inflammatory response that causes damage to the intestinal epithelium.  In particular, atrophy of the villous lining occurs which leads to flattening of the villi, causing malabsorption of nutrients. The disease also involves increased intestinal permeability, allowing more antigens, including infectious agents, to penetrate the gut mucosa and potentially exacerbate immune responses.

Symptoms of coeliac disease

Symptoms of coeliac disease include:

• bloating
• chronic diarrhoea
• constipation
• wind
• lactose intolerance 
• loose, foul-smelling stools
• nausea or vomiting
• abdominal pain
• damage to dental enamel
• delayed puberty 
• failure to thrive
• weight loss

Some people with coeliac disease have symptoms that affect other parts of the body which may include:

• dermatitis herpetiformis
• fatigue
• joint or bone pain
• mental health problems such as depression² 
• headaches, balance problems, seizures or peripheral neuropathy 
• reproductive problems in females³ 
• male infertility³ 
• Oral symptoms such as canker sores, dry mouth or a red, shiny tongue⁴ 

Diagnosis of coeliac disease

Most people with coeliac disease have one or more symptoms of the above-mentioned symptoms before they are diagnosed and begin treatment. 

The gold standard for diagnosis is duodenal biopsy which looks at the degree of flattening of intestinal villi, crypt hyperplasia, and infiltration of the lamina propria by lymphocytes.⁵ 

Treatment of coeliac disease

The various symptoms of coeliac disease usually improve and disappear when a person starts following a strict gluten-free diet. Symptoms can return if the person consumes even a small amount of gluten.⁶ 

Avoidance of gluten is essential to prevent additional immune activation and reduce the symptoms. Hydration is vital too, especially in the case of severe diarrhoea and vomiting. Nutritional support and advice from a dietitian may be necessary to address any deficiencies exacerbated by the infection.

A strict gluten-free diet can dampen that heightened immune response and allow a more normal immune response. 

What are adenoviruses? 

Adenoviruses are DNA viruses that can infect various tissues, including the respiratory tract and gastrointestinal tracts, conjunctiva, and urinary tract. There are thought to be more than 100 types of adenovirus and infection is by respiratory droplet and very common in children.⁷ 

How do adenoviruses affect the immune system?

Adenoviruses enter host cells and bind to cell surface receptors. Once inside the cell, the virus replicates leading to cell lysis and the release of new virions, which can then infect neighbouring cells.

The immune response to adenovirus involves both innate immunity and adaptive immunity. The innate immune response includes the activation of pattern recognition receptors that recognize viral components, leading to the production of type I interferons and other cytokines. The adaptive immune response involves the activation of T-cells and the production of antibodies that target the virus for destruction.⁸

Symptoms of adenovirus

The symptoms of adenovirus infection depend on the site of infection. The illness usually lasts three to five days, but serious infections can last for weeks. Symptoms can include:

• Runny nose
• Sore throat
• Fever
• Severe cough
• Swollen lymph nodes
• Headache
• Conjunctivitis

Complications of adenovirus

There are many potential complications of adenovirus infection.⁹

• ear infections
• pneumonia
• meningitis 
• skin rash
• bladder infection
• bowel infection

Treatment of adenovirus

The treatment of adenovirus infections mainly focuses on symptom management and hydration. Antiviral medications are generally not effective against adenovirus and treatment involves rest, fluids, and over-the-counter medications to relieve symptoms. 

Effect of adenovirus on coeliac disease

Adenovirus was not found to be associated with the development of coeliac disease.¹⁰ 

However, adenovirus may make symptoms of coeliac disease worse and more complicated in individuals with coeliac disease due to the immune system being activated for heightened inflammatory responses as a result of chronic exposure to gluten. When adenovirus infects these individuals, the immune response may be abnormal, leading to a worsening of the viral infection and coeliac disease symptoms.¹¹ 

In coeliac disease, the immune system is in a state of chronic activation due to ongoing exposure to gluten. This can alter the immune response to infections, including adenovirus. Coeliac patients may then have an increased susceptibility to infections due to impaired mucosal immunity. 

Moreover, the immune dysregulation in coeliac disease can result in an exaggerated inflammatory response to adenovirus. This can cause more severe symptoms and complications, as the body’s attempt to clear the virus may lead to damage to the host tissues.

Gastrointestinal effects of adenovirus in coeliac disease

Adenovirus can cause gastroenteritis with symptoms such as diarrhoea, vomiting, abdominal pain, and fever. In individuals with coeliac disease, these symptoms can also be common. Thus, the symptoms can overlap and cause issues with making an accurate diagnosis. 

The gastrointestinal symptoms of adenovirus infection may be more severe and prolonged in individuals with coeliac disease. The interaction between adenovirus and the damaged intestinal mucosa can also lead to increased villus atrophy. This further impairs nutrient absorption which can be particularly problematic in coeliac patients who are already at risk of deficiencies in vitamins and minerals due to their restricted diet and malabsorption.

Systemic effects of adenovirus in coeliac disease

The systemic effects of adenovirus in coeliac patients can be more pronounced due to the combined impact of the viral infection and the underlying autoimmune disease. The inflammatory response to adenovirus can lead to systemic symptoms such as fever, malaise, and fatigue, which can be more intense in coeliac patients due to their compromised health status.

Additionally, the increased risk of dehydration from gastrointestinal symptoms can lead to severe complications, especially in young children and the elderly. 

Diagnosis issues

Diagnosing adenovirus infections in individuals with coeliac disease can be challenging due to overlapping symptoms. Gastrointestinal symptoms such as diarrhoea and abdominal pain are common in both conditions, making it difficult to distinguish between a flare-up of coeliac disease and an adenovirus infection.

Prevention 

Preventing adenovirus infections in coeliac patients involves standard infection control practices such as hand hygiene, avoiding contact with infected individuals, and good respiratory hygiene. 

For coeliac patients, maintaining a strict gluten-free diet is crucial to reducing immune system stress and maintaining good health. Well-managed coeliac disease can potentially reduce the risk of severe complications from infections by keeping the immune system in a more balanced state.

Current research

Some research has focused on the role of viral infections in the development and exacerbation of autoimmune diseases, including coeliac disease.¹⁰ Investigating whether adenovirus and other viruses can trigger or worsen coeliac disease is an area of ongoing interest.

Areas for further research

The long-term effects of recurrent viral infections on the progression of coeliac disease are also not well understood and further understanding of this may help formulate more comprehensive care strategies for coeliac patients.

Summary

• Coeliac disease is an autoimmune condition that causes villus atrophy on exposure to gluten in the diet. 
• A strict gluten-free diet can generally manage the illness well.
• Adenoviruses are a group of viruses usually associated with relatively mild respiratory illness but with gastrointestinal and other symptoms too.
• Infections can present challenges for individuals with coeliac disease due to their compromised immune system and damaged intestinal mucosa. 
• The interaction of adenovirus infection and the activated autoimmune response in coeliac disease can worsen symptoms and cause a higher risk of complications. 
• Understanding these interactions could help healthcare providers to diagnose, treat and manage adenovirus infections in coeliac patients effectively. 
• By addressing these challenges, we can improve the quality of life and health outcomes for individuals with coeliac disease.