Maureen Leonard, MD: A Promising Celiac Disease Biomarker

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New research suggests multiple antibiotic courses may influence levels of the protein zonulin—which in part may indicate a higher risk of celiac disease.

A new study showed zonulin, the protein that which reversibly regulates the permeability of the intestines,1 is not only a potential biomarker for diagnosing preclinical celiac disease—it may better bridge our understanding of how pediatric celiac disease risk is increased by antibiotic prescription.2

Data from an abstract presented at the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego this week, showed that significantly increased levels of zonulin in infants and toddlers were associated with a greater likelihood of celiac disease diagnosis.

The team of investigators, led by Maureen Leonard, MD, clinical director of Center for Celiac Research & Treatment at MassGeneral Hospital for Children, additionally reported that an exposure to more antibiotic courses was associated with greater increases in zonulin levels—suggesting that multiple antibiotic courses may raise the risk of celiac disease in at-risk children.

In an interview with HCPLive at NASPGHAN 2023, Leonard discussed the research and its potential contribution toward understanding the triggers of celiac disease.

“We know 40% of the population carry the right genes to develop celiac disease—most of those people are eating gluten—but only 2-3% actually develop celiac disease,” Leonard said. “So there are other unknown triggers that we don't know.”

Regarding her team’s findings into the potential role of zonulin, Leonard noted that the only influential factor to the protein’s levels appeared to be antibiotic courses.

“Of course, when they're needed, they are life saving,” Leonard said. “But we want to use them as judiciously as possible, especially in these kids that we know are at risk of celiac disease, because we do see that it may influence their future risk of celiac disease onset.”


  1. Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011;91(1):151-175. doi:10.1152/physrev.00003.2008
  2. Davonte T, Valitutti F, Kenyon V, Locascio J, et al. Increased Intestinal Permeability Precedes Celiac Disease in a Birth Cohort of At-Risk Children. Paper presented at: North American Society for Pediatric Gastroenterology, Hepatology and Nutrition 2023 Annual Meeting; October 4 - 7; San Diego, CA. Accessed October 6, 2023.