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Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity

Anna Sapone12, Karen M Lammers2, Vincenzo Casolaro23, Marcella Cammarota4, Maria Teresa Giuliano4, Mario De Rosa4, Rosita Stefanile5, Giuseppe Mazzarella5, Carlo Tolone6, Maria Itria Russo7, Pasquale Esposito7, Franca Ferraraccio8, Maria Cartenì4, Gabriele Riegler1, Laura de Magistris1 and Alessio Fasano2*

Author affiliations

1 Department of Internal and Experimental Medicine Magrassi-Lanzara, Seconda Università degli Studi di Napoli, Naples, Italy

2 Mucosal Biology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA

3 Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

4 Department of Experimental Medicine, Seconda Università di Napoli, Naples, Italy

5 Institute of Food, Consiglio Nazionale delle Ricerche (CNR), Avellino, Italy

6 Department of Pediatrics, Seconda Università degli Studi di Napoli, Naples, Italy

7 Servizio di Endoscopia Digestiva, Seconda Università degli Studi di Napoli, Naples, Italy

8 Morfopatologia, Seconda Università degli Studi di Napoli, Naples, Italy

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Citation and License

BMC Medicine 2011, 9:23  doi:10.1186/1741-7015-9-23

Published: 9 March 2011



Celiac disease (CD) is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS) cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders.


CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity.


Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308), paralleled by significantly increased expression of claudin (CLDN) 4 (P = 0.0286). Relative to controls, adaptive immunity markers interleukin (IL)-6 (P = 0.0124) and IL-21 (P = 0.0572) were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR) 2 was increased in GS but not in CD (P = 0.0295). Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325) and CD patients (P = 0.0293).


This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.