Does coeliac disease cause ataxia or cognitive impairment?

乳糜泻(CD)是由于对小麦、大麦和黑麦中的一种蛋白质(面筋)过敏所致。它传统上会引起小肠疾病，导致重要营养物质的吸收受损，治疗方法是限制饮食，排除含有这些谷物提取物的食物。然而，最近发现，CD比之前认为的要常见得多(大约100-200人中有1人)，而且通常只会引起非特异性症状。一些(但不是全部)研究人员认为与CD有关的两种重要条件是共济失调(不协调)和思维和记忆障碍。问题是，许多正常人(占总人口的12%)都有面筋抗体，因此，由抗体的存在确定的对面筋的敏感性导致这些大脑疾病的研究并不是决定性的。也就是说，这可能是一个偶然的联想。此外，有一些证据表明，其他原因对大脑协调部分(小脑)的损害也可能导致面筋抗体。小脑抗体很可能与面筋发生交叉反应，反之亦然。在这种情况下，用限制性饮食治疗共济失调和面筋抗体患者可能是治疗结果，而不是疾病的原因。这个项目将用敏感、客观的方法研究CD患者(经小肠活检证实)，包括核磁共振、电子协调性测量以及思维和记忆心理测试，以确定CD是否真的与这两个问题有关。它还将研究CD小鼠模型的协调性和大脑结构。如果相关性得到证实，所有患有这些疾病的患者都需要接受CD检测，如果发现阳性，则接受限制性饮食治疗。如果不是，临床医生会相信，在这两种情况下，抗面筋抗体检测将是无关紧要和误导的。

Coeliac disease (CD) is due to an allergy to a protein (gluten) found in wheat, barley and rye. It classically causes disease of the small bowel, resulting in impaired absorption of important nutrients, and is treated by a restrictive diet eliminating foods containing extracts of these grains. However, it has recently been found that CD is much commoner than previously thought (about 1 in 100-200), and often causes only non-specific symptoms. Two important conditions linked to CD by some, but not all, researchers are ataxia (incoordination) and impairment of thinking and memory. The problem is that many normal people (12% of the population) have antibodies to gluten, so that studies suggesting that sensitivity to gluten, as determined by the presence of antibodies, causes these brain disorders are not conclusive. That is, this could be a chance association. Furthermore, there is some evidence that damage to the coordination part of the brain (the cerebellum) from other causes may also cause antibodies to gluten. It is quite possible that antibodies to the cerebellum can cross-react with gluten, and vice versa. In this case, treating patients with ataxia and antibodies to gluten with the restrictive diet may be treating the result rather than the cause of the disorder. This project will study patients with CD (proven on small bowel biopsy) with sensitive, objective methods, including MRI, electronic measures of coordination, and psychological tests of thinking and memory, to see whether CD really is associated with these two problems. It will also study coordination and brain structure in a mouse model of CD. If the associations are proven, all patients with these disorders will need to be tested for CD, and treated with the restrictive diet if found to be positive. If not, clinicians will be confident that testing for anti-gluten antibodies would be irrelevant and misleading in these two situations.