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Gruper Y, Wolff ASB, Glanz L, Spoutil F, Marthinussen MC, Osickova A, Herzig Y, Goldfarb Y, Aranaz-Novaliches G, Dobeš J, Kadouri N, Ben-Nun O, Binyamin A, Lavi B, Givony T, Khalaila R, Gome T, Wald T, Mrazkova B, Sochen C, Besnard M, Ben-Dor S, Feldmesser E, Orlova EM, Hegedűs C, Lampé I, Papp T, Felszeghy S, Sedlacek R, Davidovich E, Tal N, Shouval DS, Shamir R, Guillonneau C, Szondy Z, Lundin KEA, Osicka R, Prochazka J, Husebye ES, Abramson J. Autoimmune amelogenesis imperfecta in patients with APS-1 and coeliac disease. Nature 2023; 624:653-662. [PMID: 37993717 DOI: 10.1038/s41586-023-06776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
Ameloblasts are specialized epithelial cells in the jaw that have an indispensable role in tooth enamel formation-amelogenesis1. Amelogenesis depends on multiple ameloblast-derived proteins that function as a scaffold for hydroxyapatite crystals. The loss of function of ameloblast-derived proteins results in a group of rare congenital disorders called amelogenesis imperfecta2. Defects in enamel formation are also found in patients with autoimmune polyglandular syndrome type-1 (APS-1), caused by AIRE deficiency3,4, and in patients diagnosed with coeliac disease5-7. However, the underlying mechanisms remain unclear. Here we show that the vast majority of patients with APS-1 and coeliac disease develop autoantibodies (mostly of the IgA isotype) against ameloblast-specific proteins, the expression of which is induced by AIRE in the thymus. This in turn results in a breakdown of central tolerance, and subsequent generation of corresponding autoantibodies that interfere with enamel formation. However, in coeliac disease, the generation of such autoantibodies seems to be driven by a breakdown of peripheral tolerance to intestinal antigens that are also expressed in enamel tissue. Both conditions are examples of a previously unidentified type of IgA-dependent autoimmune disorder that we collectively name autoimmune amelogenesis imperfecta.
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Affiliation(s)
- Yael Gruper
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Anette S B Wolff
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Liad Glanz
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Frantisek Spoutil
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Mihaela Cuida Marthinussen
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway/Vestland, Bergen, Norway
| | - Adriana Osickova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Yonatan Herzig
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Yael Goldfarb
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Goretti Aranaz-Novaliches
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Jan Dobeš
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Cell Biology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Noam Kadouri
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Osher Ben-Nun
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Amit Binyamin
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Bar Lavi
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tal Givony
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Razi Khalaila
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tom Gome
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tomáš Wald
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Blanka Mrazkova
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Carmel Sochen
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Marine Besnard
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Shifra Ben-Dor
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Ester Feldmesser
- Bioinformatics Unit, Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Elisaveta M Orlova
- Endocrinological Research Center, Institute of Pediatric Endocrinology, Moscow, Russian Federation
| | - Csaba Hegedűs
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - István Lampé
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Tamás Papp
- Division of Dental Anatomy, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Felszeghy
- Division of Dental Anatomy, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Radislav Sedlacek
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Esti Davidovich
- Department of Pediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Noa Tal
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror S Shouval
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raanan Shamir
- The Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carole Guillonneau
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Zsuzsa Szondy
- Division of Dental Biochemistry, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Knut E A Lundin
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Radim Osicka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jan Prochazka
- Czech Centre for Phenogenomics & Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the Czech Academy of Sciences v.v.i 252 50, Vestec, Czech Republic
| | - Eystein S Husebye
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jakub Abramson
- Department of Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel.
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Khalaf ME, Akbar A, Alkhubaizi Q, Qudeimat M. Caries among adult patients with controlled celiac disease: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2020; 40:457-463. [PMID: 32583903 DOI: 10.1111/scd.12491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Celiac disease (CD) is one of the most common chronic gastrointestinal disorders in the world. Currently, the literature about the dental profiles of patients with celiac disease is sparse and no studies have reported on the oral conditions and caries status of CD patients in Kuwait. OBJECTIVE This study investigated the association between CD and caries experience. METHODS Two groups were examined; study and control. The study group consisted of controlled celiac disease patients. The control group consisted of subjects who were matched for age and gender to the study group participants. Both groups received clinical and radiographic examinations of their oral cavity. Parameters recorded for the study purposes were-dental caries index (decayed, missing, and filled teeth), salivary flow rates (stimulated and unstimulated), salivary buffering capacity and Lactobacilli and mutans Streptococci bacterial counts. RESULTS Patients with CD had statistically significant fewer missing teeth than the controls. There were no other significant differences. Measured stimulated and unstimulated salivary flow rates and salivary buffering capacity showed no statistical differences. Bacterial counts revealed no significant differences. CONCLUSION Adult patients with controlled CD showed fewer missing teeth than their counterparts. Other caries and salivary parameters showed no statistical differences between the two groups.
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Affiliation(s)
- Mai E Khalaf
- Faculty of Dentistry, Health Sciences Center, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabriya, Kuwait
| | - Aqdar Akbar
- Faculty of Dentistry, Health Sciences Center, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabriya, Kuwait
| | - Qoot Alkhubaizi
- Faculty of Dentistry, Health Sciences Center, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabriya, Kuwait
| | - Muawia Qudeimat
- Faculty of Dentistry, Health Sciences Center, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabriya, Kuwait
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Yılmaz S, Tuna Kırsaçlıoğlu C, Şaylı TR. Celiac disease and hematological abnormalities in children with recurrent aphthous stomatitis. Pediatr Int 2020; 62:705-710. [PMID: 31957941 DOI: 10.1111/ped.14155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/12/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is one of the most common diseases of the oral mucosa and may be related to vitamin deficiencies or systemic diseases such as celiac disease (CD). The aim of this study was to investigate the frequency of hematinic deficiency and CD in children with RAS. METHODS The medical records of patients diagnosed with RAS were reviewed for the presence of hematinic deficiencies (hemoglobin, mean corpuscular volume, ferritin, vitamin B12 , folic acid), and CD. The study group included 108 children with RAS and 57 healthy children who were evaluated for hematological abnormalities in routine evaluation. RESULTS The frequency of a family history of RAS was significantly higher in the RAS group compared to the control group (34.2% vs 7%, respectively; P < 0.001). A hematological abnormality was detected in 32.4% of the RAS group and 10.5% of the control group (P = 0.02). The prevalence of iron deficiency anemia was significantly higher in the RAS group (P = 0.037). Three (2.7%) patients with RAS were diagnosed with CD, which is a significantly higher frequency than that observed in healthy children in Turkey (P < 0.01; OR 6.03, 95% CI [2.37, 4.56]). These children had mild malnutrition, iron deficiency, and iron deficiency anemia. CONCLUSIONS Children with RAS should be evaluated for nutritional status and hematological indices, and in the case of hematological abnormalities and malnutrition screening for CD should be considered.
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Affiliation(s)
- Songül Yılmaz
- Department of Pediatrics, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatric Gastroenterology, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Tülin Revide Şaylı
- Department of Pediatrics, Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey
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