Tissue destruction and healing in Celiac Disease

项目摘要 乳糜泻（CeD）是由HLA-DQ 2+和/或HLA-DQ 2+中的膳食麸质诱导的复杂T细胞介导的肠病。 HLA-DQ 8+个体，目前影响全球人口的1%。无麸质饮食（GFD）是， 日期，治疗CeD的选择。然而，50%的CeD患者无法有效地坚持饮食 这可持续地排除了麸质，许多患者因无意中接触麸质而遭受痛苦。此外，在 30%的CeD患者有持续的高症状负担，这是由于持续的粘膜损伤，尽管 遵守GFD。GFD上的持续粘膜损伤与几种严重并发症有关， 包括恶性肿瘤，特别是淋巴瘤和骨疾病。此外，活动性CeD患者显示 广泛的临床表现，包括代谢缺陷（维生素，铁和胆固醇）， 与组织损伤程度相关。虽然在理解CeD方面取得了很大进展， 主要的差距仍然存在，特别是关于不同临床表现中涉及的生物机制， 不一致的愈合过程。例如，人们很难理解为什么，独立于程度， 绒毛萎缩，某些患者显示营养和脂质缺乏，而其他人有正常水平的 维生素胆固醇和铁此外，虽然有证据表明微生物组在CeD中的作用，但我们缺乏 关于人类CeD中小肠粘膜微生物群的信息（其更可能具有代谢作用） 并直接与免疫系统相互作用）。最后，我们对面筋之间的相互作用知之甚少， 肠上皮细胞（IEC），免疫细胞和微生物群，以及它们如何与不同的CeD联系在一起 临床表型我们的RC 2提案将检验CeD是异质性疾病的假设， 试图定义IEC，微生物群，免疫系统和遗传学之间的相互作用， 临床表现、组织破坏的严重程度和愈合能力的差异。它还将 解决我们对CeD发病机制和临床表现的理解中的关键差距，并开发 用于CeD患者的无创监测工具。我们组建了一支国际知名的 CeD、上皮细胞生物学、粘膜免疫学、微生物组学和化学领域的专家。RC2 建议是围绕多组学研究进行的背景下，横截面和干预 谷蛋白激发和去激发研究，对445名充分表征的成人和儿童患者进行。拟议 具体目标是：1）开发CeD中精确医学的方法; 2）破译机制 与CeD中的组织破坏和愈合相关，3）开发用于监测CeD的非侵入性工具 患者，以及4）为科学和医学界开发研究资源，以推进患者护理 以及基于发现和假设的科学。该应用程序旨在生成多- 需要知识基础和资源来进一步了解CeD的发病机制及其异质性， 改善个性化患者护理和随访，并开发新的治疗和预防目标。

PROJECT SUMMARY Celiac disease (CeD) is a complex T cell-mediated enteropathy induced by dietary gluten in HLA-DQ2+ and/or HLA-DQ8+ individuals, which currently affects 1% of the global population. A gluten-free diet (GFD) is, to this date, the treatment of choice for CeD. However, 50% of CeD patients are unable to effectively adhere to a diet that sustainably excludes gluten, with many patients suffering from inadvertent gluten exposure. Moreover, over 30% of CeD patients have persistent high symptom burdens, resulting from continued mucosal damage, despite adhering to a GFD. Persistent mucosal damage on a GFD is associated with several severe complications, including malignancies, especially lymphomas and bone diseases. In addition, patients with active CeD display a wide range of clinical presentations, including metabolic defects (vitamins, iron, and cholesterol) that are not correlated to the degree of tissue damage. Although much progress has been made in understanding CeD, major gaps remain, notably regarding the biological mechanisms involved in different clinical presentations and the inconsistent healing process. For instance, it is poorly understood why, independently from the degree of villous atrophy, certain patients display nutrient and lipid deficiencies, whereas others have normal levels of vitamins, cholesterol, and iron. Furthermore, while there is evidence for a role of the microbiome in CeD, we lack information on small-intestinal mucosal microbiota in human CeD (which is more likely to have metabolic effects and directly interact with the immune system). Finally, we have little knowledge about interactions between gluten, intestinal epithelial cells (IECs), immune cells, and the microbiota, and how they are linked to the different CeD clinical phenotypes. Our RC2 proposal will test the hypothesis that CeD is a heterogeneous disorder, while attempting to define interactions between IECs, microbiota, immune system, and genetics that underlie differences in clinical presentation, severity of tissue destruction, and the ability to heal. It will also address critical gaps in our understanding of CeD pathogenesis and clinical presentations, and develop tools for non-invasive monitoring of CeD patients. We have assembled a team of internationally recognized experts in the field of CeD, epithelial cell biology, mucosal immunology, microbiome, and chemistry. The RC2 proposal is anchored around multi-omics studies performed in the context of cross-sectional and interventional gluten challenge and de-challenge studies, on 445 well-characterized adult and pediatric patients. The proposed specific aims are: 1) Developing an approach to precision medicine in CeD; 2) Deciphering the mechanisms associated with tissue destruction and healing in CeD, 3) Developing non-invasive tools for monitoring CeD patients, and 4) Developing research resources for the scientific and medical community to advance patient care as well as discovery-based and hypothesis-generating science. This application aims to generate the much- needed knowledge base and resources to further our understanding of CeD pathogenesis and its heterogeneity, improve individualized patient care and follow-up, and develop new therapeutic and preventive targets.