Digestive Diseases and Sciences

, Volume 57, Issue 12, pp 3116–3125

Effect of Addition of Short Course of Prednisolone to Gluten-Free Diet on Mucosal Epithelial Cell Regeneration and Apoptosis in Celiac Disease: A Pilot Randomized Controlled Trial

Authors

  • Shalimar
    • Department of Gastroenterology and Human NutritionAll India Institute of Medical Sciences
  • Prasenjit Das
    • Department of PathologyAll India Institute of Medical Sciences
  • Vishnubhatla Sreenivas
    • Department of BiostatisticsAll India Institute of Medical Sciences
  • Siddhartha Datta Gupta
    • Department of PathologyAll India Institute of Medical Sciences
  • Subrat K. Panda
    • Department of PathologyAll India Institute of Medical Sciences
    • Department of Gastroenterology and Human NutritionAll India Institute of Medical Sciences
Original Article

DOI: 10.1007/s10620-012-2294-1

Cite this article as:
Shalimar, Das, P., Sreenivas, V. et al. Dig Dis Sci (2012) 57: 3116. doi:10.1007/s10620-012-2294-1

Abstract

Background

Identification of adjuvant treatment is necessary for rapid and effective treatment in patients with celiac disease. In a pilot randomized controlled trial, the effect of prednisolone on enterocyte apoptosis and regeneration in celiac disease was investigated.

Patients and Methods

Thirty-three treatment-naïve patients with celiac disease were randomized to either gluten-free diet (GFD, n = 17) or GFD + prednisolone (1 mg/kg for 4 weeks, n = 16). Duodenal biopsies were taken at baseline and at 4 and 8 weeks posttreatment. Six patients with functional dyspepsia were recruited as controls. All these biopsies were stained for markers of intrinsic apoptotic pathway (AIF, H2AX, p53), common apoptotic pathway (CC3, M30), apoptotic inhibitors (XIAP, Bcl2), and epithelial proliferation (Ki-67). Apoptotic (AI) and proliferation indices (PI) were compared.

Results

At baseline duodenal biopsies, the end apoptotic products H2AX and M30 were significantly increased. In comparison with those treated with GFD alone, after 4 weeks of GFD + prednisolone treatment, some markers of both intrinsic and common apoptotic pathways showed rapid decline. After prednisolone withdrawal, there was overexpression of H2AX, CC3, and p53 in the latter group. In comparison with those treated with only GFD, patients treated with prednisolone showed suppression of mucosal PI, which started rising again after withdrawal of prednisolone.

Conclusions

Apoptosis takes place in mucosal epithelium in celiac disease. Addition of short course of prednisolone suppresses apoptosis rapidly. However, it also suppresses epithelial regeneration; hence, if used, it should be withdrawn after an initial short course. (Registered at clinicaltrials.gov; NCT01045837)

Keywords

Gluten-free dietPrednisoloneImmunohistochemistryApoptotic indexCell regenerationApoptosis

Supplementary material

10620_2012_2294_MOESM1_ESM.doc (30 kb)
Supplementary material 1 (DOC 30 kb)

Copyright information

© Springer Science+Business Media, LLC 2012