Celiac Disease – From Pathophysiology to Advanced Therapies Edited by Peter Kruzliak and Govind Bhagat pdf

CELIACDISEASE–FROM
PATHOPHYSIOLOGYTO
ADVANCEDTHERAPIES
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EditedbyPeterKruzliakandGovindBhagat
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Celiac Disease – From Pathophysiology to Advanced Therapies
Edited by Peter Kruzliak and Govind Bhagat


Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech
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Notice
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted for the
accuracy of information contained in the published chapters. The publisher assumes no
responsibility for any damage or injury to persons or property arising out of the use of any
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Publishing Process Manager Romina Skomersic
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team

First published July, 2012
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from

Celiac Disease – From Pathophysiology to Advanced Therapies,
Edited by Peter Kruzliak and Govind Bhagat
p. cm.
ISBN 978-953-51-0684-5

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Contents
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Preface IX
Section 1 New Insights on Pathophysiology of Celiac Disease 1
Chapter 1 Mucosal Expression of Claudins in Celiac Disease 3
Dorottya Nagy-Szakál, Hajnalka Győrffy, Katalin Eszter Müller,
Kriszta Molnár, Ádám Vannay, Erna Sziksz, Beáta Szebeni,
Mária Papp, András Arató and Gábor Veres
Chapter 2 Antioxidant Status of the Celiac Mucosa:
Implications for Disease Pathogenesis 17
Vesna Stojiljković, Jelena Kasapović, Snežana Pejić,
Ljubica Gavrilović, Nedeljko Radlović, Zorica S. Saičić
and Snežana B. Pajović
Chapter 3 Heat Shock Proteins in Coeliac Disease 37
Erna Sziksz, Leonóra Himer, Gábor Veres, Beáta Szebeni,
András Arató, Tivadar Tulassay and Ádám Vannay
Section 2 Clinical Manifestations
and Complications of Celiac Disease 69
Chapter 4 Celiac Disease and Diabetes Mellitus Type 1 71
Mieczysław Szalecki, Piotr Albrecht and Stefan Kluzek
Chapter 5 Hematologic Manifestations of Celiac Disease 83
Peter Kruzliak
Chapter 6 Multiple Sclerosis and Celiac Disease 101
Carlos Hernández-Lahoz and Luis Rodrigo
Section 3 Detection of Cereal Toxic Peptides

Based on New Laboratory Methods 113
Chapter 7 Sensitive Detection of Cereal Fractions that
Are Toxic to Coeliac Disease Patients, Using Monoclonal
Antibodies to a Main Immunogenic Gluten Peptide 115
Carolina Sousa, Ana Real, Mª de Lourdes Moreno
and Isabel Comino
VI Contents

Section 4 Advanced Therapies in Celiac Disease 137
Chapter 8 Enzyme Therapy
for Coeliac Disease: Is it Ready for Prime Time? 139
Hugh J. Cornell and Teodor Stelmasiak
Section 5 Follow-up of Patients with Celiac Disease 165
Chapter 9 Principles and Strategies
for Monitoring Individuals with Celiac Disease 167
Mohsin Rashid
Chapter 10 On Treatment Outcomes
in Coeliac Disease Diagnosed in Adulthood 179
Claes Hallert and Susanne Roos

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Preface
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CeliacDisease(CD)orGlutenSensitiveEnteropathy(GSE)isalife‐longdisorder.Itis
characterized by inflammation in the small intestine of genetically predisposed
individualscausedbyinappropriateimmuneresponsetogluten,aproteinenrichedin
some of our common grains (wheat, rye and barley). The toxicity of gluten
is
manifestedbytheautoimmune actionofT‐lymphocytesonmucosalcellsinthesmall
intestine,disruptingitsvitalfunctionofabsorbing
nutrients from food. Epidemiological studies conducted during the past decade
revealed that CD is one of the most common lifelong disorders worldwide. CD can
manifest with a previouslyunsuspected range of clinical presentations,includingthe
typical malabsorption syndrome and a spectrum of symptoms potentially affecting
any organ system. Since CD is oftenatypical or even silent on clinical ground, many
casesremainundiagnosed andexposedtotheriskoflongtermcomplications,suchas
anemia and other hematological complications,
osteoporosis, neurological
complicationsorcancer.
Inrecentyears,therehavebeennoticeableshiftsintheageofonsetofsymptomsand
in the clinical presentation of CD, changes that seem to be associated with a delayed
introduction of gluten coupled with its reduced amount in the complications in the
diet.Another
controversialtopicconcernsthecomplicationsofuntreatedCD.Multiple
studiesthathavefocusedonthebiochemistryandtoxicityofgluten‐containinggrains
and the immune response to these grains suggest that individuals affected by CD
should be treated,irrespective of the presence or absence of symptoms and/or
associatedconditions.Nevertheless,
thereisgeneralagreementthatthepersistenceof
mucosalinjury,withorwithouttypicalsymptoms,canleadtoseverecomplicationsin
CDpatientswhodonotstrictlycomplywithagluten‐freediet.
Researchintoglutensensitivityhasneverb eenmorepopularnormoreexciting.With
regard to gluten sensitivity we

 are in a period of great change occasioned by the
applicationof new methods toidentify glutensequences as T‐cellantigens, thestudy
ofgenetic andmollecularpathophysiology,theuseofimmunohistocytochemicaland
mRNAprobingresponsetoglutenandtheresearchoffuturetherapeuticoptions.
Thisbookcovers mostof theaforementioned controversialandyet unresolved topics
by including the contributions of experts in CD. What the reader will surely find
X Preface

stimulating about this book is not only its exhaustive coverage of our current
knowledge of CD, but also provocative new concepts in disease pathogenesis and
treatment.
Todothisbookwouldhavebeenimpossiblewithoutthecontributionsoffriendsand
colleaguesfromaroundtheworldwhohavedevotedsomuchinterest
totheproject.It
hasalsobeennecessary forthem to masterthe uniquechapter‐writing skills required
ofeverymanuscriptinthisbook.Thisprojetwouldnothavebeenpossiblewithoutthe
expertiseandinvaluablecontributionandtechnicalsupportofMs.RominaSkomersic
andMs.NataliaReinicandof
theInTechpublishingteam.
It has been a privilege to put together „Celiac Disease‐From Pathophysiology to
Advanced Therapies“ that is offered in the hope that its pages will contain the
necessary information for researches, gastroenterologists, physicians, and others who
areinterestedinthisfieldofmedicineandscience.
Even if
 I do not give you any big answers inthis book, I am still proud that you are
holding it in your hands. It is because I learned, during my time as an editor and
authorofthis book,that even if wedonot reach theendpoint ofour
journey,we can
stillmakeagreatcontributiontravellingtoit.


PeterKruzliak,M.D.,BSc.
5thDepartmentofInternalMedicine
UniversityHospitalandMedicalFacultyofComeniusUniversity
Bratislava,
Slovakia
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Section 1
New Insights on Pathophysiology
of Celiac Disease