Coeliac disease

Brain Opioid Activity and Oxidative Injury: Different Molecular Scenarios Connecting Celiac Disease and Autistic Spectrum Disorder

Celiac Disease (CD) is an immune-mediated disease triggered by the ingestion of wheat gliadin and related prolamins from other cereals, such as barley and rye. Immunity against these cereal-derived proteins is mediated by pro-inflammatory cytokines produced by both innate and adaptive system response in individuals unable to adequately digest them. Peptides generated in this condition are absorbed across the gut barrier, which in these patients is characterized by the deregulation of its permeability. Here, we discuss a possible correlation between CD and Autistic Spectrum Disorder (ASD) pathogenesis. ASD can be induced by an excessive and inappropriate brain opioid activity during the neonatal period. Cereal-derived peptides produced in celiac patients cross the blood-brain barrier and bind to endogenous opioid receptors interfering with neurotransmission and generating deleterious effects on brain maturation, learning and social relations. Moreover, an increase in oxidative stress and a decrease in the antioxidant capacity, as well as an extended mitochondrial impairment in the brain, could represent a possible connection between ASD and CD. Therefore, we critically discuss the proposed relationship between ASD and CD and the possible usefulness of a gluten-free diet in ASD patients.

Immunopathogenesis and therapeutic approaches in pediatric celiac disease

Celiac Disease is an autoimmune enteropathy with increasing incidence worldwide in both adults and children. It occurs as an inflammatory condition with destruction of the normal architecture of villi on consumption of gluten and related protein products found in wheat, barley and rye. However, the exact pathogenesis is not yet fully understood. A gluten-free diet remains the main modality of therapy to date. While some patients continue to have symptoms even on a gluten-free diet, adherence to this diet is also difficult, especially for the children. Hence, there is continued interest in novel methods of therapy and the current research focus is on the promising novel non-dietary modalities of treatment. Here, we critically reviewed the existing literature regarding the pathogenesis of celiac disease in children including the role of in-utero exposure leading to neonatal and infant sensitization and its application for the development of new therapeutic approaches for these patients.

Can dietary fibre help provide safer food products for sufferers of gluten intolerance? A well-established biophysical probe may help towards providing an answer

Gluten intolerance is a condition which affects an increasing percentage of the world's population and for which the only current treatment is a restrictive gluten free diet. However could the inclusion of a particular polysaccharide, or blends of different types, help with the provision of 'safer' foods for those individuals who suffer from this condition? We review the current knowledge on the prevalence, clinical symptoms and treatment of gluten intolerance, and the use and properties of the allergens responsible. We consider the potential for dietary fibre polysaccharides to sequester peptides that are responsible for activation of the disease in susceptible individuals, and consider the potential of co-sedimentation in the analytical ultracentrifuge as a molecular probe for finding interactions strong enough to be considered as useful.

Celiac disease in pediatric patients with autoimmune hepatitis: etiology, diagnosis, and management

Celiac disease (CD) is defined as a permanent intolerance to ingested wheat gliadins and other cereal prolamins, occurring in genetically susceptible people. Persistent elevation of serum aminotransferase activity is expression of liver damage related to CD, which occurs in two distinctive forms. The most frequent is a mild asymptomatic liver injury, with a moderate increase of serum aminotransferase activities and a mild inflammatory portal and lobular infiltrate on liver biopsy (celiac hepatitis), reversible on a gluten-free diet (GFD). More rarely, severe and progressive inflammatory liver damage, induced by an autoimmune process and identified as autoimmune hepatitis (AIH), can develop and it is generally unaffected by gluten withdrawal. Surveys that included only pediatric patients report a wide range of prevalence of CD in AIH of 11.5-46% (mean 21.5%). CD and AIH share selected combinations of genes coding for class II human leukocyte antigens, which could explain their coexistence. Increased intestinal permeability and circulation of anti-tissue transglutaminase (tTG) have also been considered as further potential causes of liver damage in CD patients. tTG in the liver and in other extraintestinal tissues could modify other external- or self-antigens and generate different neo-antigens, which are responsible for liver injury in patients with CD. Patients with AIH represent a population at high risk for developing CD; screening for CD should be integrated into the diagnostic routine of all patients with AIH, with or without gastrointestinal manifestations, before starting immunosuppressive treatments. The only currently available treatment for CD is the GFD and the supportive nutritional care for iron, calcium, and vitamin deficiencies. Due to the difficulties of a GFD, in the past decade researchers have become increasingly interested in therapeutic alternatives to continuous or intermittent use of a GFD in patients with CD. Interventions addressed to correct the defect in the intestinal barrier are currently at the most advanced stage of clinical trials. The impact of a GFD on the outcome of AIH is not clear but it seems to be ineffective in the treatment of AIH. The early detection and treatment of CD, however, may prevent progression to end-stage liver failure.

Dysfunctions of the Iga system: a common link between intestinal and renal diseases

Immunoglobulin A (Iga)-isotype antibodies play an important role in immunity owing to their structure, glycosylation, localization and receptor interactions. Dysfunctions in this system can lead to multiple types of pathology. This review describes the characteristics of Iga and discusses the involvement of abnormalities in the Iga system on the development of celiac disease and Iga nephropathy.

New therapeutic strategies for celiac disease

Celiac disease is an autoimmune condition affecting genetically susceptible individuals, characterized by inflammatory damage to the small intestine following ingestion of wheat gluten or barley and rye products. The only life-long treatment is strict gluten-free diet which is difficult personally and socially, affects quality of life, not widely available, more expensive, with lower palatability, resulting in low compliance. No doubt, there is therefore an urgent need for alternative therapeutic modalities. Based on the increasing knowledge on the sequential pathophysiological events driving the intestinal inflammatory cascade, new attractive and potential therapies were starting to immerge: selecting, changing, degrading, manipulating or binding the dietary toxic environmental factors, decreasing intestinal permeability toward gluten or blocking the deamination of gluten by inhibiting tissue transglutaminase or the HLA-DQ presenting groove by carefully designed false peptide, shifting the typical Th1 to Th2 inflammatory reaction or antagonizing major proinflammatory cytokines, enhancing regulatory immune function or developing preventive vaccines, blocking adhesion molecule, inducing gluten oral or intranasal tolerance or applying epithelial repairing mitogens to oppose the mucosal destruction. Safety, effectiveness, cost and affordability are prime issues to consider. Some modalities have shown promising results in vitro. Future will show who will win the race.

Seronegative autoimmune hepatitis presenting after diagnosis of coeliac disease: a case report

The relationship between liver dysfunction and coeliac disease is well established, ranging from transaminitis to chronic liver disease. In this report, we describe for the first time the development of a 'seronegative' autoimmune hepatitis in a teenager previously diagnosed with coeliac disease. He had normal liver function tests (LFTs) at diagnosis and was strictly compliant with a gluten-free diet. On screening blood tests at 1 year post diagnosis, he presented with raised LFTs leading to a diagnosis of autoimmune hepatitis on liver biopsy, successfully treated with mycophenolate mofetil. By using screening LFTs, we may well have prevented this patient from developing disease complications.

Serum and intestinal dipeptidyl peptidase IV (DPP IV/CD26) activity in children with celiac disease

OBJECTIVE

Dipeptidyl peptidase IV (DPP IV/CD26) is involved in the degradation of proline-rich proteins such as gliadin and in modulation of the immune response. The aim of this study was to examine the possible causal connection between DPP IV enzyme activities and celiac disease (CD) in children.

PATIENTS AND METHODS

Intestinal mucosal biopsy specimens were obtained from 97 patients. The patients were divided into 3 groups: patients with active CD (n = 38), patients with malabsorption syndrome (MS) of other causes (n = 37), and control patients (n = 22). In addition, blood samples were collected from 48 patients with active CD and 50 control patients without gastrointestinal diseases. DPP IV enzyme activity was measured in the intestinal mucosal biopsy specimens and in the serum samples.

RESULTS

DPP IV activity in the small intestine correlated inversely with the grade of mucosal damage in the CD (r = -0.92, P < 0.001) and MS groups (r = -0.90, P < 0.001). Intestinal DPP IV activity was statistically significantly lower in the CD and MS groups than in the control group (P < 0.001). By contrast, serum DPP IV activity was not significantly different between the CD and control groups.

CONCLUSIONS

Our results suggest that the decrease in intestinal DPP IV activity is not specific to CD because it correlates with the level of mucosal damage in both patients with CD and those with MS. In addition, it seems that serum DPP IV activity cannot be used as a specific noninvasive diagnostic or prognostic marker of CD.