Intestinal Microbiota and Celiac Disease: Cause, Consequence or Co-Evolution?

Abstract

It is widely recognized that the intestinal microbiota plays a role in the initiation and perpetuation of intestinal inflammation in numerous chronic conditions. Most studies report intestinal dysbiosis in celiac disease (CD) patients, untreated and treated with a gluten-free diet (GFD), compared to healthy controls. CD patients with gastrointestinal symptoms are also known to have a different microbiota compared to patients with dermatitis herpetiformis and controls, suggesting that the microbiota is involved in disease manifestation. Furthermore, a dysbiotic microbiota seems to be associated with persistent gastrointestinal symptoms in treated CD patients, suggesting its pathogenic implication in these particular cases. GFD per se influences gut microbiota composition, and thus constitutes an inevitable confounding factor in studies conducted in CD patients. To improve our understanding of whether intestinal dysbiosis is the cause or consequence of disease, prospective studies in healthy infants at family risk of CD are underway. These studies have revealed that the CD host genotype selects for the early colonizers of the infant’s gut, which together with environmental factors (e.g., breast-feeding, antibiotics, etc.) could influence the development of oral tolerance to gluten. Indeed, some CD genes and/or their altered expression play a role in bacterial colonization and sensing. In turn, intestinal dysbiosis could promote an abnormal response to gluten or other environmental CD-promoting factors (e.g., infections) in predisposed individuals. Here, we review the current knowledge of host-microbe interactions and how host genetics/epigenetics and environmental factors shape gut microbiota and may influence disease risk. We also summarize the current knowledge about the potential mechanisms of action of the intestinal microbiota and specific components that affect CD pathogenesis.

Increased prevalence of pathogenic bacteria in the gut microbiota of infants at risk of developing celiac disease: The PROFICEL study

“…and Lactobacillus group). 5 , 6 Associations have also been established between the HLA-DQ2/DQ8 genotype and the gut microbiota composition, suggesting that the microbiota could also act as a predisposing factor for CD. 7 , 8 Early viral and bacterial infections have been associated with the subsequent development of CD.…”

Selected Probiotic Lactobacilli Have the Capacity To Hydrolyze Gluten Peptides during Simulated Gastrointestinal Digestion

“…The ingestion of gluten is necessary for the development of disease, and the only effective therapy for CD patients is a gluten-free diet (GFD). Additional environmental factors (such as interactions among intestinal microbiota and immunity and dietary factors) seem to be involved in the development of CD (3)(4)(5). The intestinal microbiota drives mucosal cell differentiation, intestinal permeability, and the immune response to environmental antigens (3).…”

I Can’t Eat That! Sticking to a Gluten-Free Diet

“…The former refers to the efects of perceived self-eicacy in neurophysiological systems in coping situations and an extensive summary can be found in Bandura's 'Self-eicacy: The exercise of control'. This irst level is of great importance if we link it to the recent research about the role of self-immune mechanisms and intestinal microbiota in the etiopathogenesis of coeliac disease [17][18][19][20]. A second level, and more relevant for the adherence to a GFD, is the role of self-eicacy expectation in the instillation of healthy habits and the elimination of risky behaviours.…”