Dissociation between systemic and mucosal humoral immune responses in coeliac disease

Article Abstract:

Celiac disease is a condition in which nutrients are not absorbed properly from the jejunum (a segment of the small intestine), resulting in malnutrition, diarrhea, bleeding, and low blood levels of calcium. Patients suffering from celiac disease are allergic to wheat-derived proteins (such as gliadin) and produce a class of blood-borne antibodies (immunoglobulin A; IgA) that is directed against the wheat proteins. Estimation of blood IgA levels is now routinely used to screen for celiac disease. Little is known about the nature of the immune response of the gastrointestinal mucosa (the inner lining of the gastrointestinal tract), which might operate independently of, or in concert with, the humoral (blood) immune response. A study was done to investigate this, and to determine whether indices of mucosal immune system function that can be obtained by relatively non-invasive means (e.g. antibody concentrations in saliva) are good predictors of jejunal immune responses. Blood, saliva, and fluid aspirated from the jejunum of 26 patients with untreated celiac disease, 22 patients with treated celiac disease, and 28 normal subjects were analyzed for immunoglobulin levels. In addition, intestinal secretions were collected from similar numbers of patients drawn from those three populations. Antibody levels in jejunal aspirate were elevated in patients with untreated celiac disease; this was partially normalized by dietary treatment, but some antibody levels remained high even with successful treatment. Untreated patients had higher levels of anti-gliadin antibodies than either treated patients or normal controls for all body fluids tested. There was a positive correlation between antibody levels in jejunal aspirate and in fluid aspirated from the stomach; however, there was no correlation between saliva antibody levels and those in jejunal aspirate. This indicates that salivary antibodies do not reflect the intestinal immune response. (Consumer Summary produced by Reliance Medical Information, Inc.)

Immunoglobulins, Gastrointestinal diseases

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Appraisal of gut lavage in the study of intestinal humoral immunity

Article Abstract:

The immune system of the gastrointestinal mucosa (the lining of the gastrointestinal tract) is, for the most part, independent of the systemic immune system. This complicates studies of the mucosal immune response in conditions such as Crohn's disease and celiac disease (inflammatory conditions affecting the intestine, which are thought to be mediated by immune system disorders) because immune system function must be measured directly in the gastrointestinal tract, usually requiring mucosal biopsy specimens. An alternative non-invasive procedure (gut lavage) in which patients drink large amounts of polyethylene glycol electrolyte (a non-absorbed liquid). This procedure cleanses the intestinal tract and allows rectal collection of the fluid. Antibodies secreted by the gastrointestinal mucosa will be contained in the excreted fluid. Gut lavage was carried out using 25 immunologically healthy volunteers, 15 patients with untreated celiac disease, and 10 patients with active Crohn's disease. Protease inhibitors were administered to prevent breakdown of the protein antibodies before they could be analyzed. In all patient groups, the initial samples that were contaminated with feces contained very low antibody (immunoglobulin) concentrations. Once the samples became free of fecal contamination, steady concentrations of antibodies were recovered. In patients suffering from celiac disease, high levels of immunoglobulin antibodies directed against gliadin (a protein found in wheat and gluten) were found; Crohn's disease sufferers also had high levels of immunoglobulin G (IgG), which may have leaked into the intestines from the bloodstream. Gut lavage is not only a useful method of cleaning the bowel, but is also an effective means of obtaining intestinal secretions to study humoral aspects of gastrointestinal diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Crohn's disease

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Smoking, humoral immunity, and ulcerative colitis

Article Abstract:

Ulcerative colitis is a disease in which the mucosa (lining) of the colon undergoes erosive ulceration, resulting in abdominal pain, tenderness, the passage of watery stools, and bleeding. The cause of ulcerative colitis is not known, but symptoms can be exacerbated or ameliorated by dietary alterations, and the condition may be related to the immune system. The disease afflicts predominantly nonsmokers and former smokers. Since cigarette smoking is known to affect a wide variety of immune system parameters, it is possible that smoking may suppress an immune response to ingested food, resulting in a diminution of the inflammatory processes that may result in ulcerative colitis. To investigate this, a study was carried out with 21 healthy male nonsmokers, 21 healthy male smokers (more than 10 cigarettes per day for at least one year), 21 nonsmoking ulcerative colitis patients, and 11 smokers with ulcerative colitis. Levels of immunoglobulins (immune-related proteins) in the gastrointestinal tract and blood, and levels of specific antibodies to several gastrointestinal bacteria and nutrients were determined. The only alteration detected was a decrease in the levels of immunoglobulin A (IgA) in the intestinal fluid of smokers with colitis, compared with healthy nonsmokers. (IgA is an immunoglobulin that protects the gastrointestinal tract from invasion by bacteria and viruses.) Overall, these results are not consistent with the notion that smoking protects against colitis by suppressing gastrointestinal immune responses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Smoking, Immune response, Ulcerative colitis, Immune response regulation

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