Tight Junctions, Intestinal Permeability, and Autoimmunity
Celiac Disease and Type 1 Diabetes Paradigms
Address for correspondence: Alessio Fasano, M.D., Mucosal Biology Research Center, University of Maryland School of Medicine, 20 Penn Street HSF II Building, Room S345, Baltimore, MD 21201. Voice: +410‐706‐5501; fax +410‐706‐5508. afasano@mbrc.umaryland.edu
Funding: Work presented in this review was supported in parts by grants from the National Institutes of Health Grants DK‐48373 and DK‐078699 to AF and by the innovative pilot grant, Dutch Diabetes Foundation, grant number 2006.11.019 to JV.
Abstract
Autoimmune diseases are characterized by tissue damage and loss of function due to an immune response that is directed against specific organs. This review is focused on celiac disease (CD), an autoimmune enteropathy, and type 1 diabetes (T1D), a hyperglycosaemia caused by a destructive autoimmune process targeting the insulin‐producing pancreatic islet cells. Even if environmental factors and genetic susceptibility are clearly involved in the pathogenesis of autoimmunity, for most autoimmune disorders there is no or little knowledge about the causing agent or genetic makeup underlying the disease. In this respect, CD represents a unique autoimmune disorder because a close genetic association with HLA‐DQ2 or HLA‐DQ8 haplotypes and, more importantly, the environmental trigger (the gliadin fraction of gluten‐containing grains wheat, barley, and rye) are known. Conversely, the trigger for autoimmune destruction of pancreatic ß cells in T1D is unclear. Interestingly, recent data suggest that gliadin is also involved in the pathogenesis of T1D. There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases including CD and T1D. Therefore, we hypothesize that besides genetic and environmental factors, loss of intestinal barrier function is necessary to develop autoimmunity. In this review, each of these components will be briefly reviewed.
Citing Literature
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