Celiac disease is caused by a selective lack of T cell tolerance for gluten. It is known that the enzyme tissue transglutaminase (tTG) is involved in the generation of T cell stimulatory gluten peptides through deamidation of glutamine, the most abundant amino acid in gluten. Only particular glutamine residues, however, are modified by tTG. Here we provide evidence that the spacing between glutamine and proline, the second most abundant amino acid in gluten, plays an essential role in the specificity of deamidation. On the basis of this, algorithms were designed and used to successfully predict novel T cell stimulatory peptides in gluten. Strikingly, these algorithms identified many similar peptides in the gluten-like hordeins from barley and secalins from rye but not in the avenins from oats. The avenins contain significantly lower percentages of proline residues, which offers a likely explanation for the lack of toxicity of oats. Thus, the unique amino acid composition of gluten and related proteins in barley and rye favors the generation of toxic T cell stimulatory gluten peptides by tTG. This provides a rationale for the observation that celiac disease patients are intolerant to these cereal proteins but not to other common food proteins.

No abstract

The aim of the silent pump project is to create an alarm-free environment for the patient and their family during treatment.This study assesses the feasibility of sending perfusion and volumetric pump alarms directly to the pager of the professional while the device remains silent in the patient room. This is expected to increase sleep quality, decrease alarm fatigue, and improve workflow. PITFALLS IN THE ALARM CHAIN: Assessing the feasibility of 'silent' intravenous pumps in a paediatric oncology wardAlarm overload is of great concern in hospitals using a devicepager alarm chain. Several severe pitfalls worsening alarm overload were discovered in the current hospital alarming system. These can potentially be improved by educating professionals on alarm hygiene and by differentiating alarms.