Coeliac disease: it takes three to tango!

Coeliac disease: it takes three to tango! Coeliac disease (CD), the most common food sensitive enteropathy in humans, is caused by permanent intolerance for dietary gluten. 1 2 Typical symptoms include chronic diarrhoea, abdominal distension, and failure to thrive. These symptoms are the result of a lesion in the upper small bowel characterised by (sub)total villous atrophy, hypertrophic crypts, an increased number of interepithelial lymphocytes, and a chronic inflammatory response of the lamina propria lymphocytes. IgA antibodies against endomysium are specific indicators of CD. 3 4 Yet CD is considered to be primarily a T cell mediated disease because the majority of patients express the HLA-DQ2 [DQ( 1*0501, 1*02)], and/or -DQ8 [DQ( 1*03, 1*0302)] molecules 5 6 ; gluten specific HLA-DQ restricted T cells are present at the site of the lesion in the gut 7 and withdrawal of gluten stops the disease process.