[Immunology of celiac disease]

Celiac disease is an inflammatory disorder of the small intestine induced by intake of wheat gluten and other prolamines in genetically susceptible individuals. This disease is manifested by an increased number of intraepithelial and lamina propria lymphocytes, villous atrophy, tissue remodeling and the presence of anti-transglutaminase antibodies. The most widely accepted pathogenic model is based on adaptive immunity after T CD4(+)lymphocyte stimulation by tissue transglutamine-modified gluten peptides and HLA-DQ2/DQ8 restriction, which produce proinflammatory cytokines. Gluten also activates innate immunity and epithelial cytotoxicity mediated by intraepithelial lymphocytes. Although the effect of specific antibodies remains unclear, the availability of serological and immunogenetic markers as diagnostic tools has increased our knowledge of celiac disease and has led to a reevaluation of the diagnostic criteria, especially in adults with minimal or atypical disease expression.