title: Pathomechanisms in celiac disease.
abstract: Celiac disease is an inflammatory disorder of the small intestine caused by an immune response to ingested wheat gluten and similar proteins of rye and barley. It affects at least 1 in 200 individuals, corresponding to roughly three million patients in Western Europe and Northern America alone. Data accumulated since the discovery of gluten specific T cells in the intestine of celiac disease patients the early 1990s have allowed the deciphering of the interplay between the triggering environmental factor, gluten, the main genetic risk factor, the HLA-DQ2/8 haplotypes and the autoantigen; the enzyme tissue transglutaminase (tTG). This established a key role of adaptive immunity orchestrated by lamina propria T cells responding to a set of gluten derived peptides. More recent work points to an important contribution of innate immunity triggered by a distinct gluten peptide and driven by the proinflammatory cytokine Interleukine-5 (IL-15). Together, these observations provide a unique explanation for the disease inducing capacity of gluten.
authors.affiliation: Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands. f.koning@lumc.nl
authors.forename: Frits
authors.initials: F
authors.lastname: Koning
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.forename: Nadine
authors.initials: N
authors.lastname: Cerf-Bensussan
authors.forename: Ludvig M
authors.initials: LM
authors.lastname: Sollid
mesh_terms: D002446:Celiac Disease / Q000276:immunology / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D005983:Glutens / Q000276:immunology; D006801:Humans
chemical_list: D005983:Glutens