1. Presented by: Dallas Montag Date: 12/6/16
Celiac Disease
Presented by: Dallas Montag
Date: 12/6/16

2. What is Celiac disease (CD)? 3,4,6
Intestinal inflammatory autoimmune disease in response to gluten
Destroys the villi, lining of the small intestine
Other names for the disease:
Celiac Sprue
Gluten-Sensitive Enteropathy
Sprue

3. Common Sources Of Gluten 5,8
Cookies
Pasta/Noodles
Pastries/Pies
Rolls
Salad Dressings
Beer
Bread
Bagels
Cakes
Cereal

4. Other epidemiology's include:
Celiac disease occurs principally in individuals of European descent 3,4,5
Other epidemiology's include:
Occurrence: 1 in 250 individuals
20% of first degree relatives are affected
Females > Males
Age of diagnosis

5. Celiac disease has a strong genetic component 3,5,6
Genetic Factors
Environmental Factors
HLA-DQ locus
Majority: DQ2 (DQA1*05/DQB1*02)
Minority: DQ8 (DQA1*03/DQB1*0302)
Females create a larger risk factor than males
Foods containing GLUTEN
Infant Feeding
Drug exposures
Microbial Infections (trigger)

6. What Is gluten? 4,8
Gliadin and glutenin: comprise ~80% of protein contained in wheat seed
Binds to the serotypes formed from the DQ2 and DQ8 genes
Name for proteins found in wheat and other grains such as barley, rye, and to some extent oats
Gluten helps food maintain their shape
Gluten is the “glue”

7. Immunological mechanism 1,5,6

8. The Role of tissue transglutaminase (TTG) 1,4
Calcium dependent enzyme
Extracellular and Intracellular
Irreversible crosslinking of glutamine and lysine residues
Gliadin is the preferred substrate

9. STEP 1: Entrance of gluten
STEP 2: Accumulation of gluten
STEP 3: Release of IL-15

10. STEP 4: TTG Release
STEP 5: APCs present antigens to TH cells
STEP 6: Attraction of immune cells

11. STEP 7: Tc cells attack
STEP 8: Secretion of ABs
STEP 9: Damaged
epithelial cells

12. Symptoms Abdominal Pain Dermatitis Herpetiformis Malabsorption 3,4,5,8
Seizures
Migraines
Erosion of tooth
enamel
Abdominal Pain
Bloating
Symptoms
Dermatitis Herpetiformis
Diarrhea
Weight Loss
Short Stature
Malabsorption
Vomiting
Iron Deficiency Anemia

13. Dermatitis Herpetiformis has been linked to patients with CD 2

14. CD is most commonly diagnosed by serologic tests 5,6
Routine Lab Test
Blood count, electrolytes, calcium, vitamin B12, folic acid levels
Serologic Tests
Detect antibodies, IgA and IgG
Show variability in sensitivity and specificity
Biopsy of Small Intestine

15. There are few treatments for patients with CD 4,5,6
Gluten-Free Diet
Includes all food, bath products, cosmetics, medications etc.
Small amount of gluten in food will effect a person with CD
Ex. Eating gluten- free food served on a plate with food containing gluten
Anti-inflammatory medications
Vaccine Trial
Experimental Possibility: blocking binding sites of the DQ2 and DQ8 HLA molecules???

16. Identification of deficiencies Advocacy group Continuous follow-up
Treatment cont’d 8
Consultation
Education
Lifelong diet
Identification of deficiencies
Advocacy group
Continuous follow-up

17. References & Acknowledgments
1. Sabatino AD, Vanoli A, Giuffrida P, Luinetti O, Solcia E, Corazza GR The function of tissue transglutaminase in celiac disease. Autoimmunity Reviews. 11(10): Fergunson A, Arranz E, O’Mahony S Clinical and pathological spectrum of coeliac disease-active, silent, latent, potential. Journal of The American Dietetic Association. 34(7): King AL, Ciclitira PJ Celiac disease: strongly heritable, oligogenic, but genetically complex. Molecular Genetics and Metabolism. 71(1-2): Kuper SS, Jabri B Celiac Disease Pathophysiology. Gastrointestinal Endoscopy Clinics of North America. 22(4): 1-28.

18. References & Acknowledgments
5.Murray A The widening spectrum of celiac disease1,2. American Journal of Clinical Nutrition. 69(3):
6. Sollid LM, Benedicte AL Celiac Disease Genetics: Current Concepts and Practical Applications. Clinical Gastroenterology and Hepatology. 3(9):
7. Sollid LM, Markussen G, Ek J, Gjerde H, Vartdal F, Thorsby E Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. The Journal of Experimental Medicine. 169(1):
8. Thalheimer J Getting to the bottom of food sensitivities. Environmental Nutrition. p.7.
THANK YOU DR. SPILATRO!! 

19. Questions????

20. Study questions: Multiple choice
1. Celiac disease is the result of the intolerance to the proteins most commonly found in which three grains?
A. rice, wheat, rye
B. oats, wheat, rice
C. wheat, barley, rye
D. oats, wheat, rye
2. Which of the following statements concerning celiac disease is TRUE? (select all correct answers)
A. Symptoms of celiac disease often mimic those of other intestinal disturbances.
B. It occurs more frequently amongst the elderly
C. Celiac disease occurs in 5 percent of Americans.
D. There is no cure for celiac disease.

21. Study questions: Multiple choice
3. Why does the immune system respond to gluten in patients with celiac disease?
A. It is a foreign protein
B. It is modified by the transglutaminase enzyme
C. It is very large and disrupts the villi
D. It is modified by the alanine transaminase enzyme
4. Which of the following statements concerning celiac disease is NOT true?
A. Celiac disease is more often in females than in males.
B. Celiac sprue is another name for the disease
C. Celiac disease patients have excessive growth of villi
D. Individuals with celiac disease often have malabsorption issues