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Search for atoxic cereals: a single blind, cross-over study on the safety of a single dose of Triticum monococcum, in patients with celiac disease

Barbara Zanini1, Beatrice Petroboni1, Tarcisio Not2, Nicola Di Toro2, Vincenzo Villanacci3, Francesco Lanzarotto1, Norberto Pogna4, Chiara Ricci1 and Alberto Lanzini1*

Author Affiliations

1 Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia, Italy

2 Paediatric Gastroenterology, Burlo-Garofolo Hospital and University of Trieste, Trieste, Italy

3 Histopathology Unit, University and Spedali Civili of Brescia, Brescia, Italy

4 Research Unit for Cereals Development, CRA, Rome, Italy

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BMC Gastroenterology 2013, 13:92  doi:10.1186/1471-230X-13-92

Published: 24 May 2013



Cereals of baking quality with absent or reduced toxicity are actively sought as alternative therapy to a gluten-free diet (GFD) for patients with coeliac disease (CD). Triticum monococcum, an ancient wheat, is a potential candidate having no toxicity in in-vitro and ex-vivo studies. The aim of our study was to investigate on the safety of administration of a single dose of gluten of Tm in patients with CD on GFD.


We performed a single blind, cross-over study involving 12 CD patients who had been on a GFD for at least 12 months, challenged on day 0, 14 and 28 with a single fixed dose of 2.5 grams of the following (random order): Tm, rice (as reference atoxic protein) and Amygluten (as reference toxic protein) dispersed in a gluten-free pudding. The primary end-point of the study was the change in intestinal permeability, as assessed by changes in the urinary lactulose/rhamnose ratio (L/R ratio) measured by High Pressure Liquid Chromatography. We also assessed the occurrence of adverse gastrointestinal events, graded for intensity and duration according to the WHO scale. Variables were expressed as mean ± SD; paired t-test and χ2 test were used as appropriate.


The urinary L/R ratio did not change significantly upon challenge with the 3 cereals, and was 0.055 ± 0.026 for Tm Vs 0.058 ± 0.035 for rice (p = 0.6736) and Vs 0.063 ± 0.054 with Amygluten (p = 0.6071). Adverse gastrointestinal events were 8 for Tm, Vs 11 for rice (p = 0.6321) and Vs 31 for Amygluten p = 0.0016), and, in all cases events were graded as “mild” or “moderate” with TM and rice, and as “severe” or “disabling” in 4 cases during Amygluten.


No definite conclusion can be drawn on the safety of Tm, based on no change in urinary L/R because even Amygluten, a toxic wheat protein, did not cause a significant change in urinary L/R indicating low sensitivity of this methodology in studies on acute toxicity. Tm was, however, well tolerated by all patients providing the rationale for further investigation on the safety of this cereal for CD patients.

Trial registration

EudraCT-AIFA n2008-000697-20

Triticum monococcum; Intestinal permeability; Toxicity; Celiac disease