The Interaction among Microbiota, Immunity, and Genetic and Dietary Factors Is the Condicio Sine Qua Non Celiac Disease Can Develop

Figure 1

The complex interconnection among immune system, microbiota, and environmental factors (including dietary food antigens and/or infection) in the pathogenesis of celiac disease. (a) Steady-state condition. Dietary antigens and physiologic microbiota are in symbiotic relationship with host mucosal cells; thereby a harmonized balance between pro- and anti-inflammatory factors is achieved (homeostasis). (b) Inflammation or infection. The breakdown of the normal microbial community contributes to dysbiosis. In CD patients, gluten derived peptides are recognized by antigen presenting cells, with T-cells response. Deaminated gluten peptides are presented to T-cells with subsequent release of proinflammatory cytokines. In this way, Tregs are suppressed. This fact leads to a break of balance with consequent epithelial cell damage.

(a) Steady-state conditions

(b) Inflammation or infection