D'Avino Paolo, Serena Gloria, Kenyon Victoria, Fasano Alessio
Division of Pediatric Gastroenterology and Nutrition, Mass General Hospital for Children, Harvard Medical School, Boston, MA, USA.
Mucosal Immunology and Biology Research Center, Mass General Hospital for Children, Harvard Medical School, Boston, MA, USA.
Expert Rev Clin Immunol. 2021 Mar;17(3):269-284. doi: 10.1080/1744666X.2021.1880320. Epub 2021 Feb 5.
Celiac disease (CD) is an autoimmune enteropathy triggered by ingestion of gluten. While presenting many similarities with other autoimmune diseases, celiac disease is unique in that the external trigger, gluten, and the genetic background necessary for disease development (HLA DQ2/DQ8) are well described. The prevalence of celiac disease is dramatically increasing over the years and new epidemiologic data show changes regarding age of onset and symptoms. A better understanding of CD-pathogenesis is fundamental to highlight the reasons of this rise of celiac diagnoses.
In this review we describe CD-pathogenesis by dissecting all the components necessary to lose tolerance to gluten (ingestion of gluten, genetic predisposition, loss of barrier function and immune response). Additionally, we also highlight the role that microbiome plays in celiac disease as well as new proposed therapies and experimental tools.
Prevalence of autoimmune diseases is increasing around the world. As a result, modern society is strongly impacted by a social and economic burden. Given the unique characteristics of celiac disease, a better understanding of its pathogenesis and the factors that contribute to it may shed light on other autoimmune diseases for which external trigger and genetic background are not known.
乳糜泻（CD）是一种由摄入麸质引发的自身免疫性肠病。虽然乳糜泻与其他自身免疫性疾病有许多相似之处，但它的独特之处在于，其外部触发因素麸质以及疾病发展所需的遗传背景（HLA DQ2/DQ8）已得到充分描述。多年来，乳糜泻的患病率急剧上升，新的流行病学数据显示出发病年龄和症状方面的变化。更好地理解乳糜泻的发病机制对于阐明乳糜泻诊断增加的原因至关重要。
在本综述中，我们通过剖析对麸质失去耐受性所需的所有组成部分（麸质摄入、遗传易感性、屏障功能丧失和免疫反应）来描述乳糜泻的发病机制。此外，我们还强调了微生物群在乳糜泻中的作用以及新提出的治疗方法和实验工具。
自身免疫性疾病在全球的患病率正在上升。因此，现代社会受到社会和经济负担的严重影响。鉴于乳糜泻的独特特征，更好地了解其发病机制及其促成因素可能会为其他未知外部触发因素和遗传背景的自身免疫性疾病提供线索。
