Introduction
Celiac disease (CeD) is triggered by gluten peptides that bind to HLA-DQ2 or -DQ8 in the small intestinal lamina propria which leads to gluten specific TH1 T cell activation and expansion, small intestinal inflammation, villous atrophy and intraepithelial lymphocytosis (IEL) (1, 2). With emphasis on the gut-brain axis we analyzed the consequences of active CeD inflammation on immune cell activation in the brain.
Aims & Methods
CeD is associated with symptoms of foggy mind, chronic fatigue and depression (3, 4). The immunological communication between the gut and brain axis has not been studied in-depth in CeD, including the relation of behavior and mental functioning with intestinal immune activation and resultant inflammatory changes in the blood and the brain.
NOD-DQ8 mice were sensitized to gliadin and fed a gluten-containing or gluten-free diet for 2 weeks. Key transcripts in the small intestine and brain were analyzed using qPCR and compared to FACS data of both organs.
Results
The brain is an active site of induced inflammation subsequent to CeD induction of the gut, with a highly significant upregulation of cerebral IL17a, IL23a, IL22b, IL6, IL33, Nlrp3 and COX2. Moreover, the brain dopamine/noradrenaline and neuroactive tryptophane metabolism was upregulated by enhanced production of dopamine beta hydroxylase, kynurenine-3-monooxigenase (KMO) and quinolinate phosphoribosyl transferase (Qprt).
Conclusion
The significant proinflammatory cytokine production in the brain of humanized NOD DQ8 mice with active CeD confirms a gut-brain immune communication in CeD. This is accompanied by elevated transcript levels of inflammation-induced mediators. Importantly, enzymes encoding neurotransmitter synthesis are upregulated, which may explain fatigue and mental dysfunction in patients with active CeD.
References
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(2) Verdu, E. F., & Schuppan, D. (2021). Co-factors, Microbes, and Immunogenetics in Celiac Disease to Guide Novel Approaches for Diagnosis and Treatment. Gastroenterology, 161(5), 1395–1411.e4. https://doi.org/10.1053/j.gastro.2021.08.016
(3) Belpınar, A., Dağ, Y. S., Arıcıoğlu Sülün, A., Yayan, E. H., & Varol, F. İ. (2023). The effect of anxiety and depression levels of children with celiac disease on quality of life. Journal of pediatric nursing, 73, e260–e265. https://doi.org/10.1016/j.pedn.2023.09.019
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