Settembre 2005 - Volume XXIV - numero 7

Medico e Bambino


Focus

Cari ragazzi

ALESSANDRO VENTURA

Dipartimento di Scienze della Riproduzione e dello Sviluppo, IRCCS “Burlo Garofolo”, Trieste

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A. Ventura Cari ragazzi. Medico e Bambino 2005;24(7):432 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Curare con una pillola?

LUIGI GRECO

Dipartimento di Pediatria, Università “Federico II” di Napoli

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L. Greco Curare con una pillola?. Medico e Bambino 2005;24(7):433 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

La celiachia dal vero: dal bambino all’adulto filo conduttore è l’anemia

TANIA GERARDUZZI

Scuola di Specializzazione in Pediatria, IRCCS “Burlo Garofolo”, Trieste

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T. Gerarduzzi, M. Lazzerini, F. De Franco, A. Lenhardt, I. Berti La celiachia dal vero: dal bambino all’adulto filo conduttore è l’anemia. Medico e Bambino 2005;24(7):434 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Ancora biopsia? Forse no!

STEFANO DE VIRGILIS

Dipartimento di Pediatria, Università di Cagliari

IS THE BIOPSY STILL NECESSARY? THE IMPORTANCE OF AUTOANTIBODIES AGAINST ACTIN FILAMENTS

Key words: Autoantibodies directed against actin filaments (AAA), Apoptosis

Recently, serum of celiac patients affected by autoimmune hepatitis revealed autoantibodies directed against actin filaments (AAA). The preliminary results regarding AAA showed a strong correlation between AAA antibody titre and the severity of intestinal damage. The AAA testing showed high specificity given that AAA are not found in specific conditions such as Crohn’s disease and autoimmune enteropathy. Further observations showed that the actin content of enterocytes increases if gluten is introduced in the colture. These data may suggest the possibility to avoid intestinal biopsy in case of AAA positivity, hence modifying the whole diagnostic protocol. At the same time, they may suggest that tissue transglutaminase lead to the development of gluten-dependent autoimmunity against actin with following tissue damage.

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S. De Virgilis Ancora biopsia? Forse no!. Medico e Bambino 2005;24(7):437 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Ancora biopsia? Forse sì!

STEFANO MARTELOSSI

Dipartimento di Scienze della Riproduzione e dello Sviluppo, IRCCS “Burlo Garofolo”, Trieste

IS THE BIOPSY NECESSARY? ARGUMENTS IN SUPPORT

Key words: Intestinal biopsy, ESPGHAN criteria

Usually the diagnosis of celiac disease is an easy task, thanks to the availability of good serology tests and to the intestinal biopsy, which represents a precious chance of looking at the gluten toxicity right in the gut. Although the significant improvement in the research field, biopsy is still required by the international protocol, in particular according to the ESPGHAN criteria. Intestinal biopsy offers the advantage of avoiding the gluten challenge and of promoting a better diet compliance, by giving a certain diagnosis. Moreover the biopsy can be useful in denying those cases in which a wrong diagnosis of celiac disease was put.

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S. Martelossi Ancora biopsia? Forse sì!. Medico e Bambino 2005;24(7):440 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Quale biopsia?

VITTORIO VILLANACCI

Dipartimento di II Patologia Chirurgica, Spedali Civili, Brescia

Key words: Duodenal biopsy, Intraepithelial lymphocytes

When diagnosing celiac disease, the intestinal biopsy represents a moment of close collaboration between the pathologist and the clinician. The accuracy of the hystological diagnosis depends on the number and the adequate placement of the biopsies on the slides. It is fundamental to correctly interpret the biopsy in order to recognise artefacts and to describe the different mucosal strata, the relation between villus/crypt and the presence of intraepithelial lymphocytes. All these characteristics are of great help for the clinician in order to identify non clear celiac forms.

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V. Villanacci Quale biopsia?. Medico e Bambino 2005;24(7):442 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Screening e malattia celiaca

TARCISIO NOT

Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste e IRCCS “Burlo Garofolo”, Trieste

CELIAC DISEASE AND SCREENING

Key words: Population based screening, High risk group screening

From the clinical and the epidemiological point of view, celiac disease may represent an appropriate disease model to apply a population based screening strategy. In the literature, the use of human tTG antibodies is described as an efficient screening strategy both in high risk groups and in family “case finding” series. However, population based screening is still a matter of debate, since it is yet not clear which is the most appropriate age when performing the screening and which motivations to offer to those subjects positive at the screening but still asymptomatic. It has been suggested to first identify subjects at risk by neonatal determination of HLA DQ2/DQ8 and to follow them up with periodical sierological tTG tests in order to identify early celiac patients.

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T. Not Screening e malattia celiaca. Medico e Bambino 2005;24(7):449 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Le molecole della celiachia: peptidi tossici ed endopeptidasi

GARY M. GRAY

Dipartimento di Gastroenterologia, Università di Stanford, California (USA)

THE ROLE OF TOXIC PEPTIDES AND ENDOPEPTIDASES IN CELIAC DISEASE

Key words: 33-mer peptide, Prolyl endopeptidase, Gliadin peptides

Many gluten peptides elicit T cell-proliferative responses in celiac patients. These peptides are rich in proline and glutamine residues and so extremely resistant to proteolysis. This resistance is related to their toxicity. A 33-mer peptide was identified as the primary initiator of the inflamnmatory response to gluten in celiac disease. In vitro and in vivo studies demonstrated its stability towards breakdown by all gastric, pancreatic and intestinal brushborder membrane proteases. This peptide reacts with tissue-transglutaminase with impressive selectivity and it is a potent inducer of gut-derived human T cells from celiac patients. Homologs of this peptide were found in all food grains that are toxic for celiacs but are absent from all non-toxic foods. The 33-mer peptide is detoxified by exposure to a bacterial prolyl endopeptidase, suggesting a strategy for oral peptidase supplement therapy for celiac disease in alternative to the gluten-free diet. A clinical trial to test the efficacy in vivo of endopeptidase added to gluten in preventing its multiform toxicity is ongoing.

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G.M. Gray Le molecole della celiachia: peptidi tossici ed endopeptidasi. Medico e Bambino 2005;24(7):449 https://www.medicoebambino.com/?id=0507_431.pdf

Focus

Pane senza glutine

CORRADO FOGHER

Istituto di Botanica e Genetica vegetale, Università Cattolica S. Cuore, Facoltà di Agraria, Piacenza

GLUTEN FREE BREAD

Key words: Gluten, Gliadine, Wheat genome, Wheat gene modifications

Many celiac patients find gluten free diet not tasty and difficult to follow rigorously. It is therefore auspicable to develop new gluten-free food products which taste better, including bread. Several attempts of gene modifications in order to eliminate allergic peptides from wheat have been made but unfortunately they did not lead to any significant result, given the complexity of wheat genome and the presence of a high number of toxic peptides. Ongoing experiments which genetically combine a non-allergic cereal (rice) with those wheat proteins which are necessary for the baking process, represent a new potential winning approach.

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C. Fogher Pane senza glutine. Medico e Bambino 2005;24(7):452 https://www.medicoebambino.com/?id=0507_431.pdf


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