Zusammenfassung
Seit der Entdeckung der Prolamine (Weizen, Roggen, Gerste und Hafer) als Auslöser der Zöliakie sind weitere Faktoren der Zöliakiepathogenese identifiziert worden. So wurden die Zottenatrophie der Duodenalschleimhaut und die Zöliakieserologie feste Bestandteile der Zöliakiediagnostik. In jüngster Vergangenheit wurde die Abhängigkeit der Zöliakie von HLA-DQ2 und -DQ8 beschrieben. Die Mehrheit der Bevölkerung mit diesen Markern (25%) entwickelt jedoch keine Zöliakie. Ein weiterer wichtiger Faktor ist die Gewebstransglutaminase, das Autoantigen der Zöliakie, die für die Bildung des Endomysiumantikörpers verantwortlich ist. Die genaue pathogenetische Funktion der Zöliakieantikörper ist bisher nicht bekannt. Die Immunantwort der Zöliakie verläuft vorwiegend über TH1-Lymphozyten. Mehrere Gliadinpeptide wurden charakterisiert, die sich sowohl in vitro als auch in vivo als toxisch erwiesen. Die proteolytische Resistenz der Proline und die Bildung von Glutaminsäure aus Glutamin durch der Gewebstransglutaminase, wodurch sich die Antigenität der toxischen Gliadinpeptide verstärkt, tragen zur Pathogenese der Zöliakie bei.
Abstract
Since the discovery of prolamins (wheat, rye, barley, and oats) as inducers of celiac disease, additional components of the celiac disease pathogenesis have been identified. Villous atrophy of the duodenal mucosa and serology of celiac disease became essential parameters in the diagnosis of celiac disease. Recently, the HLA-DQ2 and -DQ8 dependency of celiac disease has been described while it is not known why the majority of the population with this marker (25%) does not develop celiac disease. Another important factor of celiac disease is tissue transglutaminase, the autoantigen of celiac disease, which is responsible for the generation of the endomysium antibody. The precise pathogenetic function of celiac antibodies is still not clear. The immune response of celiac disease is dominated by TH1 lymphocytes. Several gliadin peptides have been characterized which proved to be toxic in vitro and in vivo. The proteolytic resistance of prolines as well as the transformation of glutamines to glutamic acids by tissue transglutaminase, which increase the antigenicity of toxic gliadin peptides, contribute to the pathogenesis of celiac disease.
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Zimmer, KP. Pathophysiologie der Zöliakie. Monatsschr Kinderheilkd 151, 698–705 (2003). https://doi.org/10.1007/s00112-003-0749-3
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DOI: https://doi.org/10.1007/s00112-003-0749-3