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Dietary modifications: food dependent autoimmunity in coeliac disease
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Comment
Coeliac disease has long been known to reflect an antigen specific
immune response to the gliadin component of wheat protein. Although the
exact nature of this response has been disputed, most observers
consider that CD4+ T cell mediated immunity is the critical event, with
production of cytokines and related effector functions being most
important.1 2
This view is supported by the intense
infiltration of the mucosa by activated T cells and by the fact that
coeliac disease is strongly associated with certain class II HLA
haplotypes, particularly HLA-DQ2.3 4
In addition,
experimental models which reproduce the characteristic pattern of
villus atrophy and crypt hyperplasia are dependent on activated CD4+ T
cells and cytokine production.5-8
Nevertheless, it has always been unclear how an antigen specific immune
response directed at a component of the diet can stimulate such severe
damage to the tissues of the intestine itself. The assumption
that the enteropathy is
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