title: Coeliac disease research and clinical practice: maintaining momentum into the twenty-first century.
abstract: Recent research shows that each word in the definition of coeliac disease, permanent gluten sensitive enteropathy, must now be reviewed, revised or reinterpreted. Permanent--but there are now well-documented cases of acquired disease, and perhaps also partial recovery of gut gluten tolerance. Enteropathy--gluten sensitivity is expressed in a spectrum, with a mild form seen as normal architecture with high count of intraepithelial lymphocytes. Gluten--the provoking agent--Investigators are intensively working to identify the precise toxic sequence, and to establish how this will link in with new genetic information. Mechanism of sensitivity? or hypersensitivity?--Critical to this is new knowledge on the modulation and regulation of immunity to intestinal antigens, including gliadin. A hypothesis is presented, as to the pathogenesis of gluten-sensitive enteropathy, which combines concepts of oral tolerance and of the regulation of expression of delayed type hypersensitivity reactions in the gut mucosa.
authors.affiliation: University of Edinburgh, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ferguson
mesh_terms: D002446:Celiac Disease / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics / Q000276:immunology; D003167:Complement Activation / Q000276:immunology; D005544:Forecasting; D005983:Glutens / Q000009:adverse effects* / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D000949:Histocompatibility Antigens Class II / Q000235:genetics; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000235:genetics / Q000276:immunology; D007108:Immune Tolerance / Q000235:genetics / Q000276:immunology; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D008213:Lymphocyte Activation / Q000235:genetics / Q000276:immunology; D012106:Research
chemical_list: D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II; D005983:Glutens