Department of Pathology, The Children's Memorial Health Institute, Warsaw 04-730, Poland.
Department of Gastroenterology, Division of Neurogastroenterology and Motility, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom.
World J Gastroenterol. 2017 Nov 14;23(42):7505-7518. doi: 10.3748/wjg.v23.i42.7505.
Celiac disease (CD) is a chronic immune-mediated disorder triggered by the ingestion of gluten in genetically predisposed individuals. Before activating the immune system, gluten peptides are transferred by the epithelial barrier to the mucosal lamina propria, where they are deamidated by intestinal tissue transglutaminase 2. As a result, they strongly bind to human leucocyte antigens (HLAs), especially HLA-DQ2 and HLA-DQ8, expressed on antigen-presenting cells. This induces an inflammatory response, which results in small bowel enteropathy. Although gluten is the main external trigger activating both innate and adaptive (specific) immunity, its presence in the intestinal lumen does not fully explain CD pathogenesis. It has been hypothesized that an early disruption of the gut barrier in genetically susceptible individuals, which would result in an increased intestinal permeability, could precede the onset of gluten-induced immune events. The intestinal barrier is a complex functional structure, whose functioning is dependent on intestinal microbiota homeostasis, epithelial layer integrity, and the gut-associated lymphoid tissue with its intraepithelial lymphocytes (IELs). The aim of this paper was to review the current literature and summarize the role of the gut microbiota, epithelial cells and their intercellular junctions, and IELs in CD development.
乳糜泻(CD)是一种由遗传易感性个体摄入麸质而引发的慢性免疫介导性疾病。在激活免疫系统之前,肠上皮屏障会将麸质肽转运到黏膜固有层,在那里,它们被肠道组织转谷氨酰胺酶 2 去酰胺化。结果,它们与人类白细胞抗原(HLAs),特别是在抗原呈递细胞上表达的 HLA-DQ2 和 HLA-DQ8 强烈结合。这会引发炎症反应,导致小肠肠病。尽管麸质是激活固有免疫和适应性(特异性)免疫的主要外部触发因素,但它在肠腔中的存在并不能完全解释 CD 的发病机制。有人假设,在遗传易感个体中,肠道屏障的早期破坏会导致肠道通透性增加,这可能先于麸质诱导的免疫事件发生。肠道屏障是一个复杂的功能结构,其功能依赖于肠道微生物组稳态、上皮层完整性以及带有上皮内淋巴细胞(IEL)的肠相关淋巴组织。本文旨在综述目前的文献,并总结肠道微生物群、上皮细胞及其细胞间连接以及 IEL 在 CD 发展中的作用。
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