title: Effect of addition of short course of prednisolone to gluten-free diet on mucosal epithelial cell regeneration and apoptosis in celiac disease: a pilot randomized controlled trial.
abstract: BACKGROUND
  Identification of adjuvant treatment is necessary for rapid and effective treatment in patients with celiac disease. In a pilot randomized controlled trial, the effect of prednisolone on enterocyte apoptosis and regeneration in celiac disease was investigated.
  
  
  METHODS
  Thirty-three treatment-naïve patients with celiac disease were randomized to either gluten-free diet (GFD, n = 17) or GFD + prednisolone (1 mg/kg for 4 weeks, n = 16). Duodenal biopsies were taken at baseline and at 4 and 8 weeks posttreatment. Six patients with functional dyspepsia were recruited as controls. All these biopsies were stained for markers of intrinsic apoptotic pathway (AIF, H2AX, p53), common apoptotic pathway (CC3, M30), apoptotic inhibitors (XIAP, Bcl2), and epithelial proliferation (Ki-67). Apoptotic (AI) and proliferation indices (PI) were compared.
  
  
  RESULTS
  At baseline duodenal biopsies, the end apoptotic products H2AX and M30 were significantly increased. In comparison with those treated with GFD alone, after 4 weeks of GFD + prednisolone treatment, some markers of both intrinsic and common apoptotic pathways showed rapid decline. After prednisolone withdrawal, there was overexpression of H2AX, CC3, and p53 in the latter group. In comparison with those treated with only GFD, patients treated with prednisolone showed suppression of mucosal PI, which started rising again after withdrawal of prednisolone.
  
  
  CONCLUSIONS
  Apoptosis takes place in mucosal epithelium in celiac disease. Addition of short course of prednisolone suppresses apoptosis rapidly. However, it also suppresses epithelial regeneration; hence, if used, it should be withdrawn after an initial short course.
authors: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors: Shalimar
authors: Prasenjit
authors: P
authors: Das
authors: Vishnubhatla
authors: V
authors: Sreenivas
authors: Siddhartha
authors: S
authors: Datta Gupta
authors: Subrat K
authors: SK
authors: Panda
authors: Govind K
authors: GK
authors: Makharia
mesh_terms: D000293:Adolescent; D000328:Adult; D017209:Apoptosis / Q000187:drug effects; D015415:Biomarkers; D002446:Celiac Disease / Q000178:diet therapy* / Q000188:drug therapy*; D049109:Cell Proliferation / Q000187:drug effects; D002648:Child; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000166:cytology / Q000187:drug effects*; D004847:Epithelial Cells / Q000166:cytology / Q000187:drug effects; D006801:Humans; D007413:Intestinal Mucosa / Q000166:cytology / Q000187:drug effects*; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011239:Prednisolone