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Can Celiac Disease Disappear After Allogeneic Bone Marrow Transplant?

Celiac.com 01/06/2014 - A team of researchers recently set out to clarify the role of the immune system and intestinal epithelium in the origins of celiac disease.

Bone Marrow Diagram: CC--Wikimedia CommonsThe research team included S. Ben-Horin, S. Polak-Charcon,I. Barshack, O. Picard, E. Fudim, M. Yavzori, C. Avivi, C. Mardoukh, A. Shimoni, Y Chowers, Y. and Maor, of the Department of Gastroenterology in Chaim Sheba Medical Center at Tel-Aviv University, Tel Hashomer in Tel-Aviv, Israel.

For five years, the team followed a patient with childhood celiac disease who had undergone an allogeneic bone marrow transplant (BMT) for chronic myelogenous leukemia, and subsequently resumed consuming a gluten-containing diet.

Using standard serology testing, along with CFSE-based proliferation assays of peripheral blood CD4+ cells and of intestinal LPL towards gliadin-TTG antigens, the team assessed immunological memory to gliadin epitopes in both the control patient and in 5 newly diagnosed celiac patients.

They used combined immuno-histochemistry and fluorescent in-situ hybridiazation (FISH) to determine the origin of the intestinal lymphocytes.

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They found that the patient remained healthy for more than 5 years of follow-up after receiving BMT from a HLA-matched woman, and ceasing the gluten-free diet. The continued to show negative periodic antibodies tests and unremarkable serial duodenal biopsies.

In vitro tests showed lack of a memory response of the patient's peripheral blood and lamina propria CD4+ T-cells towards TTG, gliadin or TTG-treated gliadin, whereas memory responses were common in the newly diagnosed celiac patients.

Immuno-FISH of post-BMT duodenal mucosa showed that all the epithelial cells had the chromosomal phenotype of XY. In contrast, CD45+ lymphocytic lineage cells were all donor-derived XX cells, presumably originating in the transplanted bone marrow and re-populating the intestinal wall.

The resolution of celiac disease after allogeneic BMT does occur, and is associated with absent gliadin-specific memory response, and with a dichotomous lymphocyte-epithelial chimeric intestine. These findings suggest that the origins of celiac disease are deeply connected to the immune system, rather than the epithelial area.

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5 Responses:

 
Sue
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said this on
09 Jan 2014 2:41:32 PM PST
Fascinating! Does make me question if I should be on the bone marrow transplant list of donors. I'd hate for someone to recover and then learn they have celiac disease instead of luekemia.

 
Roberta
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said this on
13 Jan 2014 6:11:31 PM PST
What does one have to do to get on a bone marrow transplant list?

 
sc'Que?
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said this on
14 Jan 2014 2:07:55 AM PST
This study seems like it will have long-reaching effects in how celiac disease is researched in the future. Please follow up on this kind of study!

 
Hilary
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said this on
14 Jan 2014 3:48:43 AM PST
Jefferson! as usual you find the most interesting finds. This article and the study are something that gives hope to all of us with celiac disease. The science and reporting were excellent from the looks. Thanks again so much.

 
Pussycat21
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said this on
14 Jan 2014 4:22:44 PM PST
This article is very interesting as the coeliac disease is cured. For any researchers reading this post I have three coeliacs in my immediate family. My daughters also has Hashimotos and POCS. When my children were young they contracted Kawasaki Disease and were given gamma goblin blood products ( a mix of different peoples' immune systems). For the five years after the transfusion their autoimmune diseases improved immensely. Some research into this would be interesting as it may not take bone marrow to get a cure.




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