Differential Mucosal IL-17 Expression in Two Gliadin-Induced Disorders: Gluten Sensitivity and the Autoimmune Enteropathy Celiac Disease

Abstract

Background: The immune-mediated enteropathy, celiac disease (CD), and gluten sensitivity (GS) are two distinct clinical conditions that are both triggered by the ingestion of wheat gliadin. CD, but not GS, is associated with and possibly mediated by an autoimmune process. Recent studies show that gliadin may induce the activation of IL-17-producing T cells and that IL-17 expression in the CD mucosa correlates with gluten intake. Methods: The small-intestinal mucosa of patients with CD and GS and dyspeptic controls was analyzed for expression of IL-17A mRNA by quantitative RT-PCR. The number of CD3+ and TCR-γδ lymphocytes and the proportion of CD3+ cells coexpressing the Th17 marker CCR6 were examined by in situ small-intestinal immunohistochemistry. Results: Mucosal expression of IL-17A was significantly increased in CD but not in GS patients, compared to controls. This difference was due to enhanced IL-17A levels in >50% of CD patients, with the remainder expressing levels similar to GS patients or controls, and was paralleled by a trend toward increased proportions of CD3+CCR6+ cells in intestinal mucosal specimens from these subjects. Conclusion: We conclude that GS, albeit gluten-induced, is different from CD not only with respect to the genetic makeup and clinical and functional parameters, but also with respect to the nature of the immune response. Our findings also suggest that two subgroups of CD, IL-17-dependent and IL-17-independent, may be identified based on differential mucosal expression of this cytokine.

Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity

“…As other studies have not shown changes in intestinal permeability and absorption ( 20,23 ), it could be hypothesized that the anemia and weight loss may in part depend on the self-restricted diet commenced by the patients, which excluded many foods. Th e other clinical characteristics are very similar to those observed in the allergic patients.…”

Editorial: Non-Celiac Wheat Sensitivity: Separating the Wheat from the Chat!

“…Two recent studies have attempted to categorize GS further. Th e fi rst study (incorporating 13 active CD patients, 11 gluten-sensitive patients, and 7 controls) suggested that the mucosal expression of interleukin-17, an adaptive immune marker, was signifi cantly increased in celiac patients but not in GS patients ( 42 ). Furthermore, it was observed that the HLA DQ2 or DQ8 prevalence in GS was similar to controls (36 % for GS and 29 % for controls).…”

Gluten Sensitivity in Pediatrics: A Clinical Conundrum

“…The first recent description of NCGS has been reported by Sapone et al [8], while the existence of this condition has been confirmed by Biesiekierski et al [9 • ] in 2011, who demonstrated for the first time that individuals with a history of gluten sensitive symptoms did indeed respond to a double-blind gluten challenge. Since then, several reports from different groups have been published.…”