Gluten Enteropathy Presentation by

Esfa khawar

Definition of Gluten Enteropathy Gluten enteropathy means disorder in small

intestine caused by the intake of Gluten Gluten is a protein found in wheat, barley,

cereal, pasta etc. In plant ,there is a defensive protein called

Prolamins »» Gluten is one of the type of Prolamins >>

contain toxic part Gliadin These toxic prolamins give the plant a

protection mechanism for their survival

Prolamins

Dr. Alessio Fasano “All humans lack the enzymes required to

break down gluten.” The human gut is not equipped to break down

prolamins small enough to absorb any nutrients from them.

This toxic affect is worse for people suffering from celiac disease genetically.

Celiac Disease

Gluten enteropathy >>also called >>Celiac disorder

Celiac disease is >>AUTOimmune disease

Under normal conditions, the immune system is designed to protect toxins, bacteria, viruses, cancer cells, etc.

AUTOimmune disease

In people with autoimmune disease, the immune system gets “confused” between

antigen and healthy body tissue it’s a tragic case of mistaken identity. “”The main difference between gluten intolerance

and celiac disease is the role of immune system towards Gluten.””

Mechanism When a person intake gluten in diet (cereal, pasta ,wheat), enters into your stomach. Your stomach will reduce the size and structure of the food, turning it into chyme, and send it along to the small intestine to break it down further

and harvest the nutrients.

Intake food Enters in stomach Chyme Small

intestine

Cont.

In the case of gluten proteins (like gliadin), they need to be broken down by the body before they’re useful, which is difficult for us humans.

Dr. Alessio Fasano “All humans lack the enzymes required to

break down gluten.” As these gliadin particles bounce around in the

small intestine, they start causing damage to the villi

Cont. INNATEimmune system/ inflammation undigested gliadin particles in the small

intestine causes a release of IL-8,(Inter leukin) triggering the initial gut inflammation

IL8 activates INNATE immune system, first layer of defense to react

Their encounter start damaging small intestine lining Enterocytes hence cause GUT INFLAMATION at above gut wall.

LEAKY GUTZonulin/ tight junction Since INNATE immune system is not strong

enough for gliadin>>pass the barrier >> tricks ZONULINE

(Zonulin is (Protein) a “gatekeeper” protein in the human gut that controls the tight junctions of the gut)

>> cause zonulin level to rise >> Tight Junction in return Opens Wide enough for large particle gluten to enter inside Gut wall.

Passing of Gluten through tight junction is called LEAKY GUT.

Now, gliadin is accumulating underneath the gut wall, causing the enterocytes to release IL-15 (Inter leukin)

ACTIVATES immune system Special Forces sending Intra Epithelial Lymphocytes (IEL’s) with “inflammatory mediators” such as TNF and IFN that

contribute to more severe enterocyte damage causing inflammation The more severely those cells are damaged, the

worse the intestinal permeability gets and soon left with full-blown leaky gut syndrome. Now gliadin (and everything else), can freely pass

through the gut wall

Gliadin Cross link with EnzymeAdaptive immune system Gliadin pass through gut wall >> enters

underneath the Gut Wall >> Crosslink with Enzyme Tissue Transglutaminase (tTG)

tTG= enzyme secreted to repair damaged Intestinal cell Enterocytes

>> on Crosslink of Gliadin/tTG >> ADAPTIVE immune system enters ( special, powerful and strong response ) contains Antibodies >> comes into action>> recognize and destroys the antigens.

Cont.

However Greater is the GUT Leak << Greater

will be Cross link << Antibodies mistakenly start attacking

enterocyte cells ..this situation is called Autoimmune

disease

3 Inflammations

Remember Immune system is already busy fighting Gliadin above the Gut wall causing initial inflammation

immune system fighting Gliadin is inside Gut Wall causing inflammation

Now Antibody’s mistaken attack on intestine cell causing Inflammation.

all three processes leading to the destruction of the enterocyte cells lining the gut wall in their own special way.

Over time, these attack gets bad enough that they completely destroy the microvilli of the intestinal lining.

start infiltrating the body

Flattening

Damaged completely

Summary of Mechanism

Gluten

intolerance