Tye-Din Jason A, Galipeau Heather J, Agardh Daniel
Immunology Division, The Walter and Eliza Hall Institute, Parkville, VIC, Australia.
Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
Front Pediatr. 2018 Nov 21;6:350. doi: 10.3389/fped.2018.00350. eCollection 2018.
Our understanding of celiac disease and how it develops has evolved significantly over the last half century. Although traditionally viewed as a pediatric illness characterized by malabsorption, it is now better seen as an immune illness with systemic manifestations affecting all ages. Population studies reveal this global disease is common and, in many countries, increasing in prevalence. These studies underscore the importance of specific HLA susceptibility genes and gluten consumption in disease development and suggest that other genetic and environmental factors could also play a role. The emerging data on viral and bacterial microbe-host interactions and their alterations in celiac disease provides a plausible mechanism linking environmental risk and disease development. Although the inflammatory lesion of celiac disease is complex, the strong HLA association highlights a central role for pathogenic T cells responding to select gluten peptides that have now been defined for the most common genetic form of celiac disease. What remains less understood is how loss of tolerance to gluten occurs. New insights into celiac disease are now providing opportunities to intervene in its development, course, diagnosis, and treatment.
在过去的半个世纪里，我们对乳糜泻及其发病机制的理解有了显著的进展。虽然传统上认为乳糜泻是一种以吸收不良为特征的儿科疾病，但现在更应将其视为一种具有全身表现的免疫性疾病，可影响所有年龄段。人群研究表明，这种全球性疾病很常见，而且在许多国家，其患病率正在上升。这些研究强调了特定的HLA易感基因和麸质摄入在疾病发展中的重要性，并表明其他遗传和环境因素也可能起作用。关于病毒和细菌微生物与宿主相互作用及其在乳糜泻中的改变的新数据，为环境风险与疾病发展之间的联系提供了一个合理的机制。虽然乳糜泻的炎症病变很复杂，但HLA的强关联性突出了致病性T细胞对特定麸质肽作出反应的核心作用，这些麸质肽现已针对乳糜泻最常见的遗传形式进行了定义。目前尚不清楚的是，对麸质的耐受性是如何丧失的。对乳糜泻的新见解现在为干预其发展、病程、诊断和治疗提供了机会。
