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One of our board members was kind enough to access the full research
article.  I offer the basics here.  jyr

 

Narrative Review - Celiac Disease: Understanding a Complex Autoimmune
Disorder.  Annals of Internal Medicine.  Authored by Armin Alaedini, PhD and
Peter H.R. Green, MD.
<http://www.annals.org/cgi/content/abstract/142/4/289>
http://www.annals.org/cgi/content/abstract/142/4/289

ABSTRACT.  Celiac disease is a common autoimmune disorder that has genetic,
environmental, and immunologic components.  It is characterized by an immune
response to ingested wheat gluten and related proteins of rye and barley
that leads to inflammation, villous atrophy, and crypt hyperplasic in the
intestine.  The disease is closely associated with genes that code for human
leukocyte antigens DQ2 and DQ8.  Transglutaminase 2 appears to be an
important component of the disease, both as a deamidating enzyme that can
enhance the immunostimulatory effect of gluten and as a target autoantigen
in the immune response.  Sensitive and specific serologic tests, including
those for anti-transglutaminase antibody, are facilitating fast and
noninvasive screening for celiac disease.  Thus, they are contributing to a
more accurate estimate of the prevalence of the disease and its association
with other disorders.  Celiac disease is associated with increased rates of
anemia, osteoporosis, cancer, neurologic definits, and additional autoimmune
disorders.  A gluten-free diet is the mainstay of safe and effective
treatment of celiac disease, although its effect on some of the
extraintestinal manifestations of the disease remains to be determined.

 

CONCLUSIONS.  

Celiac disease is a multisystem autoimmune disorder that is currently
believed to affect about 1 % of the general population. Although the
clinical classification and diagno-sis of the disease are based on
gastrointestinal manifesta-tions, patients are increasingly identified after
the extra-intestinal complications of the disease are detected. The
clinician should therefore not only consider celiac disease in patients who
are experiencing the classic gastrointestinal symptoms but also in those who
have disorders whose prevalence is high among patients with celiac disease.
Use of serologic markers has revolutionized the screening and diagnosis of
celiac disease. Current evidence indicates that IgA anti-transglutaminase 2
and IgA antiendomysial anti-bodies have good sensitivity and specificity and
are superior to other markers for celiac disease. Nevertheless,
confirma-tion of characteristic mucosal damage on intestinal biopsy remains
the gold standard for diagnosis.

Substantial progress in the understanding of celiac dis-ease has been made
in the past decade. Both the adaptive and innate arms of the immune system
are involved in the response to gluten and the subsequent action of lamina
propria and intraepithelial lymphocytes in driving the au-toimmune response
that eventually leads to mucosal dam-age. Expression ofHLA-DQ2 and HLA-DQ8
molecules is an essential genetic component of the disease, being neces-sary
for the immune reaction against gluten. Furthermore, apart from becoming a
target antigen of the immune re-sponse, transglutaminase 2 enzyme appears to
be involved in modifying and enhancing the immunostimulatory effect of
gluten peptides. However, many important questions remain, especially with
regard to additional molecular and genetic factors that drive the immune
response against glu-ten, the mechanism of involvement of the
transglutaminase 2 autoantigen in the immune response, the underlying
fac-tors that affect the association of celiac disease with other disorders,
and the role of a gluten-free diet in treating the extraintestinal
complications of celiac disease. A better un-derstanding of the underlying
mechanism of pathogenesis of celiac disease and associated disorders will
help in devising new strategies for diagnosis and treatment of the disease,
including prevention of its long-term complications, and serve as a model
for investigation of other autoimmune disorders.

 

 

Janet Rinehart, Chairman

Houston Celiac Support Group

www.houstonceliacs.org <http://www.houstonceliacs.org/> 

281-679-7608

 

 

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