The review proposes a model of the etiology of celiac disease. It describes how an enteroviral attack by a lytic virus leads to hyper-extracellular Transglutaminase 2, (Tg2), evident at all stages of the disease by the presence of anti-tTG. The demand for Tg2 is supplied by both the cell and the lytic virus. The demand leads to excess Tg2 passing through the cell wall, excess ingress of Ca2+, the destruction of the mitochondria by Ca2+, and pyroptosis of the cell. The increase in extracellular Tg2 during the cell’s life and following pyroptosis has two effects. First, it binds a C1r inhibitor to the vascular wall, preventing C1r-LP from converting prehaptoglobin (zonulin) into haptoglobin, causing the weakening of the tight junctions among the epithelial cells and allowing the entry of extraneous luminal materials and particularly the access of Tg2 arterial and luminal, as it is now open directly to the lumen and the mesenchyme structure. It is this Tg2 that damages the villus structure as the Tg2 binds fibronectin into the mesenchyme, causing scarring, shrinkage, and turning the villi into the rigid scarred structures characteristic of CD. The model suggests why CD is a chronic lifelong disease reactivated upon the resumption of gluten consumption. A discussion of refractory CD follows. The paper explains how extracellular transglutaminase causes prehaptoglobin (zonulin) and damages the extracellular membrane. Thus, prehaptoglobin (zonulin) is a symptom, not a cause. Notably, the paper demonstrates that the basic tenet of autoimmune diseases that the cells destroy themselves is incorrect, at least for CD. Applying this etiology to other conditions may be relevant because of the almost universal glutaminolysis in cells and the substantial amount of Gluten in modern diets.
A relationship between autism and autoimmunity is well known and various autoimmune diseases were associated with the autistic spectrum. Relapsing polychondritis is a rare autoimmune disease manifested mainly in adults. Following is the first case presentation of a girl presented with relapsing polychondritis who was on the autistic spectrum. Several mechanisms can be envisioned to connect those two diseases
Recently, a male patient, presented to multiple medical specialties that eventually led to development of diarrhea and weight loss followed by eventual review by a gastroenterologist and a specific diagnosis of Whipple’s disease, a systemic disorder first described more than a century ago, but only recently recognized to be caused by Tropheryma whipplei . In this report, an updated review of this apparently very rare clinical disorder was done, including studies permitting a specific diagnosis of this disorder along with exclusion of other intestinal mucosal disorders that may potentially mimic Whipple’s disease.
Gluten free diet is the only proven treatment for celiac disease. This study aims to investigate the dietary challenges of adults with celiac disease. A web-based survey was completed by adult patients diagnosed with CD across Saudi Arabia. The survey included questions exploring demographics, the challenges in their diet as well as questions about their behaviour of eating out. Most of the participants were females and more than half are living in Riyadh. Furthermore, 65.7% were diagnosed by bowel biopsy and 72.3% were diagnosed for more than 1 year, 95.8% are following a gluten-free diet but 51.8% are not under a nutritional program 57.1% are not following up with a dietitian. Furthermore, 96.4% of participants considered restaurants are problems in providing gluten-free food and 86.1% are avoiding restaurants. This study concluded that adults with celiac disease are following GFD without follow -up with health care providers (HCPs), this can lead to increase many complications of this disease. Moreover, increasing the awareness about CD and GFD is important among patients, HCPs and society including, families and friends and people dealing with food business.
With an average of 1/200 affected people around the world, celiac disease still lacks a cure. Here a concept of a viral therapy with certain design degrees of freedom is suggested to the scientific community with the hope that a well experienced and equipped research team is able to endeavour such project. Also, safety concerns of the viral therapy about escape mutations and trophism are covered. These ideas can be extended to any autoimmune disease with an etiological alteration of the memory T-cells, paving the way to safer alternatives to the immunological reboot.
Background: The coronavirus disease 2019 (COVID-19) pandemic has immeasurably struck healthcare systems worldwide, generating disruptions in the care of chronic disease patients. We herein aimed to assess the impact of the COVID-19 pandemic on celiac disease (CD) patients. Materials and Methods: An online questionnaire with 46 cascade questions was designed and distributed through the social media channel of the Romanian CD patient association. Results: Altogether, 113 respondents accessed the questionnaire, of whom 95 adult CD patients with complete responses were included in the analysis. The median age of the surveyed participants was 44 years, with the majority (86.3%) being female. Despite concerns, the availability of gluten-free products was reported as being unchanged compared to before the pandemic by 3 out of 4 respondents. Also, our survey did not reveal significant changes regarding adherence to gluten-free diet during the pandemic, as assessed by Biagi score. However, 25.3% of respondents reported feelings of anxiety and 29.5% of depression, but only 3.2% benefited from psychological or psychiatric support. About one quarter of participants postponed their medical checkups due to fear of getting infected. One fifth of respondents declared having been infected with the novel coronavirus, but only 10% of them were hospitalized. One third of respondents had already gotten the COVID-19 vaccine and reported only minor side effects. Also, over half (57.9%) of survey participants declared they had not received enough information during the pandemic. Conclusions: Among our study respondents, availability and adherence to gluten-free diet was not markedly changed during the pandemic, but they were significantly impacted by the lack of CD-specific information about SARS-CoV2 infection and vaccination.
Immune checkpoint inhibitors are increasingly used as adjuvant therapy in oncology; however, they have short and long-term side effects. A major one is the surge in autoimmune diseases. The number of those conditions is continuously increasing, and recently, celiac disease was added to the list. Since celiac disease is associated with CTLA-4 polymorphism and since the disease is underdiagnosed and since the patient is at risk for various cancers, upon anti-CTRA-4 immune therapy, the loss of function of the CTLA-4 protein can predispose them to overt celiac disease. The present review highlights some potential mechanisms for CTLA-4 dysfunction, putting the patients at risk of celiac disease induction.
The advent of biologic medication has substantially improved the evolution of juvenile idiopathic arthritis (JIA), producing better social insertion and a clearly superior quality of life. However, there is a possibility of immunological disorders following treatment with biological substances, which may have long-term consequences in treated patients. The extension of clinical trials to pediatric patients has allowed a closer follow-up of both the evolution of the disease under treatment and the consequences of biological treatments. This article aims to analyze this aspect according to studies conducted in many countries by several authors. For each biological agent, the immunological events consisted primarily of the appearance of serious infections, such as tuberculosis, malignancies, response to vaccines, the appearance of autoimmune manifestations, and, last but not least, the appearance of anti-drug antibodies. These studies have shown that there are large differences in side effects between different biological agents, and, therefore, it has been proposed that a dossier be conducted to monitor these side effects. An international pharmacovigilance database called PharmaChild has already been created.
