Study of two ectopeptidases in the susceptibility to celiac disease: two newly identified polymorphisms of dipeptidylpeptidase IV

Serum and intestinal dipeptidyl peptidase IV (DPP IV/CD26) activity in children with celiac disease

OBJECTIVE

Dipeptidyl peptidase IV (DPP IV/CD26) is involved in the degradation of proline-rich proteins such as gliadin and in modulation of the immune response. The aim of this study was to examine the possible causal connection between DPP IV enzyme activities and celiac disease (CD) in children.

PATIENTS AND METHODS

Intestinal mucosal biopsy specimens were obtained from 97 patients. The patients were divided into 3 groups: patients with active CD (n = 38), patients with malabsorption syndrome (MS) of other causes (n = 37), and control patients (n = 22). In addition, blood samples were collected from 48 patients with active CD and 50 control patients without gastrointestinal diseases. DPP IV enzyme activity was measured in the intestinal mucosal biopsy specimens and in the serum samples.

RESULTS

DPP IV activity in the small intestine correlated inversely with the grade of mucosal damage in the CD (r = -0.92, P < 0.001) and MS groups (r = -0.90, P < 0.001). Intestinal DPP IV activity was statistically significantly lower in the CD and MS groups than in the control group (P < 0.001). By contrast, serum DPP IV activity was not significantly different between the CD and control groups.

CONCLUSIONS

Our results suggest that the decrease in intestinal DPP IV activity is not specific to CD because it correlates with the level of mucosal damage in both patients with CD and those with MS. In addition, it seems that serum DPP IV activity cannot be used as a specific noninvasive diagnostic or prognostic marker of CD.

Celiac disease

Celiac disease is more prevalent than it was previously thought to be, and screening of selected population groups may reveal many new cases. Tissue transglutaminase appears to have a significant role in the degradation of gliadin and antigen production. Specific gliadin epitopes have been defined using T-cell responses. Bone disease is a significant problem for patients with celiac disease but management guidelines are being developed. Refractory sprue (nonresponsive celiac disease) appears to be a manifestation of enteropathy-associated T-cell lymphoma in most cases.

Genetics of celiac disease

Celiac disease (CD) is a chronic inflammatory disease of the gut resulting from ingestion of gluten, occurring in genetically susceptible individuals. The strong genetic association of CD with the DQ2 and DQ8 HLA heterodimers has been known for long, but others non-HLA genes are involved. In order to identify susceptibility genes to CD, several studies have been performed, based on either linkage analyses or candidate gene approaches. This review describes these different studies and their results. The hypothesis of the implication of the DR53 heterodimer in the HLA region has been proposed. The existence of a susceptibility locus on chromosome 5q has been evidenced through linkage analysis and candidate gene strategies have revealed the role of CTLA-4 and of the immunoglobulin gamma genes in the disease.