**Meet the editors**

Dr Peter Kruzliak graduated in general medicine from the Jessenius Medical Faculty of Comenius University, Martin (Slovakia) and obtained his BSc in molecular biology and genetics. He is working at the department of physiology and pathophysiology at the Slovak Academy of Sciences. His main scientific interest is focused on pathophysiology, molecular biology and advanced

therapies of coronary artery disease and celiac disease.

Dr Govind Bhagat is Professor of Clinical Pathology in the Department of Pathology and Cell Biology at Columbia University Medical Center in New York, USA. He is Director of the Hematopathology Division and supervises research of the Mucosal Immunology laboratory of the Celiac Disease Center in the Division of Gastrointestinal and Liver Diseases. Dr Bhagat has been involved

in celiac disease research for over 12 years and has helped characterize novel disease associations and manifestations of celiac disease. His specific interests are in characterizing the histopathology of celiac disease and its associated disorders and the pathogenesis of lymphomas occurring in individuals with celiac disease, as well as elucidating mechanisms regulating inflammation and immune responses in the intestinal tract. He has presented at national and international meetings on these subjects and has authored or coauthored over 150 publications in peer reviewed journals, reviews and book chapters. Dr Bhagat serves on the editorial boards of three journals, including BMC Gastroenterology where he is an Associate Editor.

Contents

**Preface IX** 

**Section 1 New Insights on Pathophysiology of Celiac Disease 1** 

Dorottya Nagy-Szakál, Hajnalka Győrffy, Katalin Eszter Müller, Kriszta Molnár, Ádám Vannay, Erna Sziksz, Beáta Szebeni,

Chapter 1 **Mucosal Expression of Claudins in Celiac Disease 3** 

Mária Papp, András Arató and Gábor Veres

**Implications for Disease Pathogenesis 17**  Vesna Stojiljković, Jelena Kasapović, Snežana Pejić, Ljubica Gavrilović, Nedeljko Radlović, Zorica S. Saičić

**and Complications of Celiac Disease 69** 

Chapter 4 **Celiac Disease and Diabetes Mellitus Type 1 71** 

Chapter 5 **Hematologic Manifestations of Celiac Disease 83** 

**Based on New Laboratory Methods 113** 

Carolina Sousa, Ana Real, Mª de Lourdes Moreno

**Are Toxic to Coeliac Disease Patients, Using Monoclonal Antibodies to a Main Immunogenic Gluten Peptide 115** 

Chapter 6 **Multiple Sclerosis and Celiac Disease 101**  Carlos Hernández-Lahoz and Luis Rodrigo

Chapter 7 **Sensitive Detection of Cereal Fractions that** 

**Section 3 Detection of Cereal Toxic Peptides** 

and Isabel Comino

Erna Sziksz, Leonóra Himer, Gábor Veres, Beáta Szebeni, András Arató, Tivadar Tulassay and Ádám Vannay

Mieczysław Szalecki, Piotr Albrecht and Stefan Kluzek

Chapter 2 **Antioxidant Status of the Celiac Mucosa:** 

Chapter 3 **Heat Shock Proteins in Coeliac Disease 37** 

and Snežana B. Pajović

**Section 2 Clinical Manifestations** 

Peter Kruzliak

### Contents

#### **Preface XI**


#### **Section 2 Clinical Manifestations and Complications of Celiac Disease 69**


#### X Contents


### Preface

Celiac Disease (CD) or Gluten Sensitive Enteropathy (GSE) is a life‐long disorder. It is characterized by inflammation in the small intestine of genetically predisposed individuals caused by inappropriate immune response to gluten, a protein enriched in some of our common grains (wheat, rye and barley). The toxicity of gluten is manifested by the autoimmune action of T‐lymphocytes on mucosal cells in the small intestine, disrupting its vital function of absorbing

nutrients from food. Epidemiological studies conducted during the past decade revealed that CD is one of the most common lifelong disorders worldwide. CD can manifest with a previously unsuspected range of clinical presentations, including the typical malabsorption syndrome and a spectrum of symptoms potentially affecting any organ system. Since CD is often atypical or even silent on clinical ground, many cases remain undiagnosed and exposed to the risk of long term complications, such as anemia and other hematological complications, osteoporosis, neurological complications or cancer.

In recent years, there have been noticeable shifts in the age of onset of symptoms and in the clinical presentation of CD, changes that seem to be associated with a delayed introduction of gluten coupled with its reduced amount in the complications in the diet. Another controversial topic concerns the complications of untreated CD. Multiple studies that have focused on the biochemistry and toxicity of gluten‐containing grains and the immune response to these grains suggest that individuals affected by CD should be treated, irrespective of the presence or absence of symptoms and/or associated conditions. Nevertheless, there is general agreement that the persistence of mucosal injury, with or without typical symptoms, can lead to severe complications in CD patients who do not strictly comply with a gluten‐free diet.

Research into gluten sensitivity has never been more popular nor more exciting. With regard to gluten sensitivity we are in a period of great change occasioned by the application of new methods to identify gluten sequences as T‐cell antigens, the study of genetic and mollecular pathophysiology, the use of immunohistocytochemical and mRNA probing response to gluten and the research of future therapeutic options.

This book covers most of the aforementioned controversial and yet unresolved topics by including the contributions of experts in CD. What the reader will surely find

#### X Preface

stimulating about this book is not only its exhaustive coverage of our current knowledge of CD, but also provocative new concepts in disease pathogenesis and treatment.

To do this book would have been impossible without the contributions of friends and colleagues from around the world who have devoted so much interest to the project. It has also been necessary for them to master the unique chapter‐writing skills required of every manuscript in this book. This projet would not have been possible without the expertise and invaluable contribution and technical support of Ms. Romina Skomersic and Ms. Natalia Reinic and of the InTech publishing team.

It has been a privilege to put together "Celiac Disease ‐ From Pathophysiology to Advanced Therapies" that is offered in the hope that its pages will contain the necessary information for researches, gastroenterologists, physicians, and others who are interested in this field of medicine and science.

Even if I do not give you any big answers in this book, I am still proud that you are holding it in your hands. It is because I learned, during my time as an editor and author of this book, that even if we do not reach the endpoint of our journey, we can still make a great contribution travelling to it.

> **Peter Kruzliak, M.D., BSc.** 5th Department of Internal Medicine University Hospital and Medical Faculty of Comenius University Bratislava, Slovakia

X Preface

treatment.

stimulating about this book is not only its exhaustive coverage of our current knowledge of CD, but also provocative new concepts in disease pathogenesis and

To do this book would have been impossible without the contributions of friends and colleagues from around the world who have devoted so much interest to the project. It has also been necessary for them to master the unique chapter‐writing skills required of every manuscript in this book. This projet would not have been possible without the expertise and invaluable contribution and technical support of Ms. Romina Skomersic

It has been a privilege to put together "Celiac Disease ‐ From Pathophysiology to Advanced Therapies" that is offered in the hope that its pages will contain the necessary information for researches, gastroenterologists, physicians, and others who

Even if I do not give you any big answers in this book, I am still proud that you are holding it in your hands. It is because I learned, during my time as an editor and author of this book, that even if we do not reach the endpoint of our journey, we can

**Peter Kruzliak, M.D., BSc.**

Bratislava, Slovakia

5th Department of Internal Medicine

University Hospital and Medical Faculty of Comenius University

and Ms. Natalia Reinic and of the InTech publishing team.

are interested in this field of medicine and science.

still make a great contribution travelling to it.

**Section 1** 

**of Celiac Disease** 

**New Insights on Pathophysiology** 
