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Intestinal permeability in coeliac disease: insight into mechanisms and relevance to pathogenesis
  1. Martine Heyman,
  2. Juliette Abed,
  3. Corinne Lebreton,
  4. Nadine Cerf-Bensussan
  1. INSERM U989, Université Paris Descartes, Paris, France
  1. Correspondence to Dr Nadine Cerf-Bensussan, INSERM U989, Université Paris Descartes, 156 rue de Vaugirard, Paris 75730, France; nadine.cerf-bensussan{at}


Coeliac disease is a gut disease driven by an abnormal immune response towards dietary gluten in genetically susceptible individuals. Whether and, if so, how abnormal transport of gluten across the gut epithelium may participate in the pathogenesis of coeliac disease remains debatable. This paper summarises the interactions of gluten-derived peptides with the intestinal epithelium and discusses the mechanisms that control their transport across the epithelium. It shows how recent data point to a key role for the transcellular pathway and highlights the ‘Trojan horse’ role of secretory IgA which can hijack the transferrin receptor and allow the rapid translocation of intact gluten peptides into the mucosa. These recent findings might be useful for the design of new treatments.

  • Transcytosis
  • secretory IgA
  • transferrin receptor
  • transcellular permeability
  • para-cellular permeability
  • intestinal transport
  • epithelial cells
  • food antigen absorption
  • transferrin receptor
  • immunoglobulin A
  • intestinal epithelial handling
  • IgA deficiency
  • neonatal Fc receptor
  • gut immunology
  • epithelial permeability
  • epithelial transport
  • epithelial barrier
  • coeliac disease

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  • Funding The authors are supported by grants from Institut National de la Santé et de la Recherche Médicale (INSERM), from Agence Nationale pour la Recherche (ANR 06-Physio 006 and ALIA 017-01), from the “Foundation Princesse Grace” and from the “Association Française des Intolérants au Gluten (AFDIAG)”. JA is supported by a PhD fellowship from ANR ALIA 017.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Comité de Protection des Personnes (CPP) Ile de France II.

  • Provenance and peer review Not commissioned; externally peer reviewed.