Article

Celiac disease: caught between a rock and a hard place.

Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, The Netherlands.
Gastroenterology (impact factor: 11.68). 11/2005; 129(4):1294-301. DOI:10.1053/j.gastro.2005.07.030 pp.1294-301
Source: PubMed

ABSTRACT Celiac disease (CD) is an intestinal disorder caused by an intolerance to gluten, proteins in wheat. CD is an HLA-associated disease: virtually all patients express HLA-DQ2 or HLA-DQ8. Recent work has shown that these disease-predisposing HLA-DQ molecules bind enzymatically modified gluten peptides and these HLA-DQ peptide complexes trigger inflammatory T-cell responses in the small intestine that lead to disease. In addition, gluten induces innate immune responses that contribute to the tissue damage that is characteristic for CD. Thus, CD patients are caught between a rock and a hard place: the disease is caused by a combination of adaptive and innate immune responses that both are triggered by gluten. These findings explain the disease-inducing properties of gluten and provide valuable clues for the development of alternative treatment modalities for patients. They also may be of relevance for our understanding of other multifactorial disorders including IBD and HLA-associated autoimmune diseases.

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Keywords

adaptive
 
alternative treatment modalities
 
Celiac disease
 
disease-inducing properties
 
disease-predisposing HLA-DQ molecules bind enzymatically
 
gluten
 
gluten induces innate immune responses
 
gluten peptides
 
HLA-associated autoimmune diseases
 
HLA-associated disease
 
HLA-DQ peptide complexes
 
HLA-DQ2
 
HLA-DQ8
 
inflammatory T-cell responses
 
innate immune responses
 
intestinal disorder
 
multifactorial disorders
 
small intestine
 
tissue damage
 
valuable clues
 

Frits Koning