Immunological phenomena in the jejunum and serum after reintroduction of dietary gluten in children with treated coeliac disease.

Abstract

Jejunal mucosal immunoglobulin-containing cells of all three major classes (IgA, IgM, IgG) were increased in coeliac children on gluten-containing diets but only IgM cell numbers were raised in those on gluten-free diets. Patients with subtotal villous atrophy had greater numbers of immunoglobulin-containing cells than patients with normal mucosa. In previously treated patients studied before and after three months on a gluten-containing diet ther was an increase in all three classes of cell, IgM containing cells showing the greatest proportional rise. Basement membrane staining with anti-IgA serum occurred in coeliacs and was most intense in untreated patients. Apart from one patient with very low levels of serum IgA, serum immunoglobulins did not differ from normal. However, after reintroduction of gluten to the diet a significant fall in serum IgM concentrations occurred compared with levels in the same patients while on gluten-free diets. It seems probable that both IgA and IgM systems are important in the immunopathogenesis of the small intestinal lesion of childhood coeliac disease.

Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

“…Changes in Ig-cell populations were shown to persist longer than histological damage in CD. This finding is consistent with some earlier studies [16,17], though it contradicts other reports [12,35].…”

“…There are different relative proportions of IgA-, IgM-, and IgG-containing cells reported to take part in the subepithelial infiltrate, in CD [3,7,12,17,34,35,37] and in CMPI [12,20,33,36]. A consistent difference between CD and CMPI was not demonstrated until this study, based on the evaluation of defined mucosal tissue units and on double-stain immunofluorescent histology suitable for quantitative work [2].…”

Complement studies in children with treated coeliac disease after gluten challenge

“…After gluten challenge, deposition of immunoglobulins and C 3 have been observed in the basement membrane and lamina propria of the small bowel in treated adult coeliac patients [5,18]. An increase of IgA-and IgM-containing cells in the mucosa after gluten challenge has been demonstrated by Lancaster-Smith et al [9]. In vitro studies with coeliac jejunal mucosa have shown an increased synthesis of IgA and IgM after challenge with gluten [10], much of this being antibody against gluten [7].…”

Antibodies in celiac disease: implications beyond diagnostics

“…Such findings differed considerably from those in healthy individuals. [46][47][48][49][50][51] It was also found that during a gluten-free diet, the antibody deposits disappeared, but when gluten was reintroduced in the diet of celiac disease patients, the antibody deposition rapidly reappeared. 49,52,53 After the identification of TG2 as the celiac disease autoantigen, 36 it was demonstrated that the patient autoantibodies also target the autoantigen TG2 in tissues.…”

“…45 Immediately thereafter, similar IgA deposits in the basement membrane area were reported in the small-bowel mucosa of untreated celiac patients in conjunction with increases in the number of immunoglobulin-containing cells. [46][47][48][49] Immunoelectron microscopic studies revealed heavy deposits of IgA in the basement membrane of surface epithelial cells, in crypt epithelium, around the subepithelial fibroblasts and in the walls of blood vessels in the intestinal mucosa of Antibodies in celiac disease S Caja et al 104 celiac patients. Such findings differed considerably from those in healthy individuals.…”