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Q J Med 1999; 92: 119-122
© 1999 Association of Physicians

Commentary

Is gliadin mispresented to the immune system in coeliac disease? A hypothesis

F. Biagi, K.P. Zimmer1, P.D. Thomas, H.J. Ellis and P.J. Ciclitira

From the Gastroentrology Unit (GKT), The Rayne Institute, St Thomas' Hospital, London, UK and 1 University Children's Hospital, 48149 Münster, Germany

Professor P.J. Ciclitira, Department of Gastroenterology, The Rayne Institute, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH

The primary pathogenic trigger in coeliac disease (CD) is still unknown. We present the hypothesis that in CD the enterocytes could metabolize gliadin through an immunogenic pathway instead of a tolerogenic one. The result of this abnormal presentation of gliadin to the immune system would be the activation of lamina propria T cells, followed by the onset of enteropathy.


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