Influence of intestinal microbiota in celiac disease pathogenesis and risk

Abstract

Celiac disease (CD) is a chronic enteropathy triggered by cereal gluten proteins in genetically predisposed individuals. The etiology is strongly associated with the genes of the human leukocyte antigen (HLA) encoding the DQ2/DQ8 molecules. Most CD patients carry this genotype but this is also present in the 40% of the general population and only a small percentage develops the disease. Thus, the HLA-DQ genotype is necessary but not solely responsible for the disease development. Gluten is the main environmental trigger but its intake neither fully explains the onset nor its clinical manifestations. Other environmental factors (e.g. early feeding practices, infections, intestinal microbiota) have been associated with the risk of developing CD. The only treatment for CD patients is the adherence to a gluten free diet (GFD), but the compliance with this dietary strategy is complicated because gluten is present in many foods. Therefore, the identification of modifiable environmental factors that contribute to CD onset is critical for the development of strategies to reduce its incidence. Observational studies in CD patients revealed imbalances in the intestinal microbiota which could contribute to the pathogenesis of the disease. It has been proposed that these imbalances are not only a secondary consequence of the disease but could also be a predisposing factor. To understand whether gut microbiota imbalances play a role in CD onset and pathogenesis, in vitro, animal and human prospective and intervention studies have been conducted in the context of the present PhD Thesis. The global aim of this Thesis has been to improve the understanding of the role played by intestinal microbiota in the pathogenesis and risk of CD, and the possibilities of contributing to disease prevention and treatment by modulating gut microbiota composition. Chapter 1 includes two in vitro studies investigating the influence of components of the gut microbiota (bifidobacteria and enterobacteria) on the maturation and functions of immunocompetent cells (dendritic cells), and on gluten toxicity in the intestinal epithelium (Caco-2 cells). We have observed that some Bifidobacterium strains are able to reduce the activation of dendritic cells and ameliorate the toxicity of gluten on intestinal epithelial cells. In Chapter 2 the effects of the administration of Bifidobacterium longum CECT 7347 was evaluated in an in vivo model of gluten induced enteropathy in newborn rats, resulting in a reduced proinflammatory cytokine production in the small intestine and CD4+T cell numbers in peripheral blood. Chapter 3 includes two observational studies in humans to unravel whether breast-feeding and human milk composition and/or the host genotype (HLA-DQ) are related to the microbiota, thereby influencing the later development of CD. We concluded that both factors may contribute to the early intestinal colonization of the infant?s gut, influencing the Bifidobacterium spp. numbers. Human milk composition also varies in CD and non-CD mothers, modifying the supply of bifidobacteria and protective immune factors to the offspring. Finally, in Chapter 4 we have studied the potential beneficial effects of the administration of B. longum CECT 7347 in addition to the GFD to children with newly diagnosed CD. This study demonstrates that the bifidobacteria slightly reduces serum inflammatory markers and restored the gut microbiota composition.