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Celiac Disease: Methods and Protocols

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Celiac Disease: Methods and Protocols. Edited by M N Marsh (Pp 300; US$99.50). Totowa, New Jersey, USA: Humana Press, 2000.

Michael Marsh's latest book on coeliac disease started out at a distinct disadvantage as I took it with a pile of novels to read while on a summer holiday in Provence. However, he need not have worried; this is a distinctive book and, to someone interested in coeliac disease, it came as a refreshing approach to the subject.

Marsh was charged with editing a volume in a new series on “Methods in Molecular Medicine”. He was a good choice as he has spent virtually the whole of his professional life working on coeliac disease and, in particular, on the morphology of the intestinal mucosa. He has dedicated the volume to the late Anne Ferguson, who did so much to further our understanding of mucosal immunity, particularly in respect of coeliac disease.

The book starts with a good introductory chapter that clearly states the modern understanding of gluten sensitivity and clinically apparent coeliac disease. Then follow three chapters outlining genetic methods, ranging from DNA extraction through positional cloning to complex family studies. These describe the techniques, as used in Richard Houlston's laboratory, and are comprehensive with informative notes. However, they are not for the uninitiated in this area.

Tatham and colleagues have produced a good and easily accessible description of the modern classification of cereal proteins, as well as a detailed account of extraction, separation, and purification processes. Koning's group has written three excellent complementary chapters on characterising gluten peptides using mass spectrometry, on producing synthetic peptides for T cell recognition, and on identifying specific peptide binding regions on HLA-DQ molecules. Ludvig Sollid's group follows this with another excellent chapter on the establishment and use of gliadin specific T cell lines and clones. This is written by obvious leaders in this field and the accompanying notes reveal a wealth of useful technical detail for the budding researcher.

Marsh's group is responsible for two chapters on morphometry. The first is probably the best account yet that they have produced on their methods of morphometric analysis of small intestinal mucosa. The second chapter describes their methods for detecting changes in gluten sensitive rectal mucosa. These chapters are didactic and reflect the many years of careful observations made by Marsh and his coworkers. One wonders whether there is anything further to be measured in the small intestinal mucosa, but it is useful to have such a comprehensive account of these methods.

Riccardo Troncone and his colleagues describe the use of in vitro rectal gluten challenge as a means of studying immunological phenomena in coeliac disease. These are interesting observations but of limited usefulness. It is disappointing that the immune morphometric methods of Marsh are not used in these studies. I was sorry not to see a description of organ culture of small intestinal mucosa and the possibilities arising from it.

Paul Ciclitira's laboratory has a longstanding interest in in situ hybridisation techniques and there is a good account of these from workers with first hand knowledge of the problems and pitfalls, as well as the usefulness. Per Brandtzaeg is the acknowledged guru of gastrointestinal mucosal immunohistochemistry. His group provide two chapters, one on quantitative polymerase chain reaction for the assessment of cytokine mRNA expression, and a comprehensive one on immunohistochemistry. These chapters are extensive and detailed, with useful practical notes from an expert. Dieterich (on an ELISA for tissue transglutaminase antibodies) and Unsworth (on routine serological tests) provide two practically useful chapters for more routine diagnostic laboratories. Finally, the Edinburgh group, founded by Anne Ferguson, describes the technique and uses of whole gut lavage fluid analysis.

Marsh has assembled a group of international authorities on the various aspects he has chosen. The book achieves the aim of providing good working methods for many of the research techniques currently used in coeliac disease. One wonders about the readership of such a volume. I suspect it will be quite specialised but for those who, as Marsh says (page 8) want to “plunge into this complex pool of intrigue, this book should provide good introductory exposure”. Ah well! From the wizardry of Marsh and colleagues, I return to the witchcraft of Harry Potter.