title: Involvement of CD40-CD40 ligand in uncomplicated and refractory celiac disease.
abstract: OBJECTIVE
  Cognate interaction between CD40 on antigen-presenting cells and CD40 ligand (CD40L) on T cells is a crucial costimulatory signal in T-cell activation. In this study, we investigated CD40-CD40L expression in the duodenum of uncomplicated and refractory celiac disease patients, and explored the ex vivo effects of CD40L blockade on cytokine production and the T-helper cell type 1-specific transcription factor T-bet.
  
  
  METHODS
  CD40L and colocalization of CD40 with the dendritic cell markers CD11c and CD123 were investigated by confocal microscopy on tissue sections of duodenal biopsy samples obtained from 14 uncomplicated celiac patients before and after 12 months of gluten-free diet, 5 refractory celiac patients, and 12 controls. CD40 was also analyzed by flow cytometry on single cell suspension of mucosal biopsies. Treated celiac biopsies were stimulated with peptic-tryptic digest of gliadin (PT-gliadin) with or without an anti-CD40L-neutralizing antibody. Interferon (IFN)-γ and interleukin (IL)-17 were measured by ELISA (enzyme-linked immunosorbent assay). T-bet, CD40, and CD40L were determined by immunoblotting.
  
  
  RESULTS
  CD40 and CD40L expression was higher in uncomplicated untreated and refractory celiac patients than in controls; the expression returned to normal after gluten-free diet in uncomplicated patients. Flow cytometric analysis confirmed that most CD40(+) cells were dendritic cells. The addition of the anti-CD40L antibody to treated celiac biopsies significantly inhibited the PT-gliadin-induced production of IFN-γ and IL-17, and mucosal T-bet.
  
  
  CONCLUSIONS
  Our results indicate that the CD40-CD40L pathway has a key role in celiac disease. Disruption of CD40-CD40L interaction may offer a therapeutic alternative in refractory celiac disease.
authors.affiliation: First Department of Medicine, Fondazione IRCCS Policlinico S. Matteo, Centro per lo Studio e Cura della Malattia Celiaca, University of Pavia, Pavia, Italy. a.disabatino@smatteo.pv.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Sabatino
authors.forename: Laura
authors.initials: L
authors.lastname: Rovedatti
authors.forename: Stefania
authors.initials: S
authors.lastname: Vetrano
authors.forename: Francesca
authors.initials: F
authors.lastname: Vidali
authors.forename: Paolo
authors.initials: P
authors.lastname: Biancheri
authors.forename: Maria
authors.initials: M
authors.lastname: Rescigno
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Macdonald
authors.forename: Gino R
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D000328:Adult; D000938:Antigen-Presenting Cells / Q000276:immunology; D001706:Biopsy; D039521:CD11c Antigen / Q000378:metabolism; D019013:CD40 Antigens / Q000276:immunology / Q000378:metabolism*; D023201:CD40 Ligand / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000378:metabolism*; D002446:Celiac Disease / Q000178:diet therapy / Q000276:immunology*; D016207:Cytokines / Q000096:biosynthesis*; D003713:Dendritic Cells / Q000276:immunology*; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005903:Gliadin / Q000378:metabolism; D006801:Humans; D015151:Immunoblotting; D007249:Inflammation / Q000378:metabolism; D007371:Interferon-gamma / Q000096:biosynthesis; D020381:Interleukin-17 / Q000096:biosynthesis; D053650:Interleukin-3 Receptor alpha Subunit / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D020825:T-Box Domain Proteins / Q000378:metabolism*; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism*; D000098815:T-bet Transcription Factor
chemical_list: D039521:CD11c Antigen; D019013:CD40 Antigens; D016207:Cytokines; C115022:IL3RA protein, human; D020381:Interleukin-17; D053650:Interleukin-3 Receptor alpha Subunit; D020825:T-Box Domain Proteins; D000098815:T-bet Transcription Factor; D023201:CD40 Ligand; D007371:Interferon-gamma; D005903:Gliadin