Immunocytochemistry using a specific monoclonal antibody 9A7,y was used to identify receptors for calcitriol (1,25 (OH) Little is known of the cellular localisation of vitamin D receptors or vitamin D regulated proteins in the human intestine, or of the effects of disease on vitamin D regulated functions. Such studies might provide insight into the mechanisms by which vitamin D influences calcium absorption. In gluten induced enteropathy (coeliac disease) mucosal damage resulting in villous atrophy is most noticeable in the proximal small bowel, as the duodenum and jejunum bear the brunt of the enteropathy induced by ingested gluten. Calcium malabsorption with hypocalcaemia, osteopenia, and fractures are well recognised features.6 7 We have used immunocytochemical methods to examine whether changes in the distribution of vitamin D receptors and a calcium regulated protein (alkaline phosphatase) occurred in villous atrophy seen in patients with coeliac disease. As calcium absorption declines after the menopause, we were also interested to look for the presence of oestrogen receptors in duodenal mucosa.
Methods
BIOPSY SPECIMENSDistal duodenal biopsy specimens were obtained at endoscopy from eight patients with gluten induced enteropathy. Four untreated patients showed severe (3) and moderate (1) mucosal damage. Only one of four patients who had received a gluten free diet had a normal mucosa. The others showed persisting severe (2) or mild (1)
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