Celiac disease is a chronic digestive and autoimmune disorder that affects the small intestine and affects about 1% of the general population. It is caused by the ingestion of gluten, which is a major protein that is stored in wheat, rye, and barley. These proteins drive the immune response to celiac disease. Gastric and pancreatic enzymes are unable to break down the gluten proteins, which creates an autoimmune response. Celiac disease is caused by genetic factors and having a family history of celiac disease increases the risk of developing the disease by 10-15%. MHC class II genes are the genes responsible for the disease. 90% of patients with celiac disease express the gene, HLA-DQ2.5. The patients who are most at risk for developing the disease are homozygous with HLA-DQ2. Celiac disease can be hard to diagnose because it presents with any age and various symptoms. Because there are different clinical features at the time of diagnosis, celiac disease is broken into 3 forms: classical, non-classical, and subclinical. The classical form is most common in children under 5 years old, who present with “chronic diarrhea, poor appetite, weight loss, abdominal distension, muscle wasting, and mood changes” (Catassi et al., 2022). Non-classical is the most prevalent and consists of non-specific intestinal complaints, chronic fatigue, nutritional deficiencies, etc. Subclinical is diagnosed by screening programs or case finding in high risk groups, such as having a family history of celiac disease.
Celiac Disease is also associated with other autoimmune diseases such as type 1 diabetes and Hashimoto’s thyroiditis. 4.5% of patients with type 1 diabetes will also have celiac disease. Testing for celiac disease involves using serological markers, HLA gene determination, and/or a small intestinal biopsy. The appearance of serum antibodies is a key factor in the diagnostic process. People who are screened for celiac and have a gluten-containing diet will show IgA class anti-TG2, which is the best screening test to start with. The most effective treatment for celiac disease is a major lifestyle change, which is to switch to a gluten-free diet. It is nutritionally safe and enables healing without major complications. Even though cutting out gluten from a diet is the most effective treatment, there is still ongoing research for new treatments such as nutritional support, pharmacological agents, and stem-cell transplantation. Further research is needed for new treatments and therapies that could hopefully improve the quality of life for patients with celiac disease.
Catassi, C., Verdu, E. F., Bai, J. C., & Lionetti, E. (2022). Coeliac disease. The Lancet, 399(10344), 2413–2426. https://doi.org/10.1016/s0140-6736(22)00794-2
Very interesting subject because it seems there are so many who have been told they are gluten free. With this background, many should also look into the Coeliac disease, for there might be more to their history. I have found an article that states not only do guidelines deal with some of the related disorders of being gluten-free but may also be related to dermatitis herpetiformis, that is characterized to have deposits in the dermal papillae. These are lesions that come with gluten withdraw, which may be related to coeliac disease. Hopefully, there is a cure in the future.
ReplyDeleteAl-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, Mulder CJ, Lundin KEA.(2019) European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. Jun;7(5):583-613. doi: 10.1177/2050640619844125.
I found it very interesting that there is little to no treatment for celiacs disease even though it affects nearly 1% of the population. While that may not sound like much, 1% is hundreds of thousands of people. I found an article published by Mayo Clinic that states that there are some therapies in the works, but nothing substantial has been achieved yet. It also states that they need to stay away from other non-foods items as well, such as makeup and over the counter drugs.
ReplyDeleteMayo Foundation for Medical Education and Research. (2023, September 12). Celiac disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225
You mentioned ongoing research for new treatments such as nutritional support, pharmacological agents, and stem-cell transplantation, so I spent some time on PubMed and found an article with some new developments in Celiac disease treatment. There were three strategies that seemed to have potential in bypassing the current treatment's effectiveness and quality of life given to a patient. The three include a non-immunogenic gluten delivery, blocking immunogenic gluten exposure, and inhibiting transglutaminase. The first strategy would be to present non-immunogenic variants of gluten through the use of genetically engineered non-immunogenic wheat capable of not inciting an immune response. The second strategy would be to block gluten exposure through either digesting the gluten through delivery of exogenous peptidases, sequestering the gluten in the intestinal lumen or decreasing epithelial permeability leading to a glutenless internal environment. And the last strategy of inhibiting transglutaminase would use an oral inhibitor called ZED1227 to stop glutamine from turning into glutamic acid and decreasing the body's immunogenicity to gluten. While the article says that these methods are still in the works, I really like how effective they could be once fleshed out!
ReplyDeleteReference:
DeleteMachado M. V. (2023). New Developments in Celiac Disease Treatment. International journal of molecular sciences, 24(2), 945. https://doi.org/10.3390/ijms24020945