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Pathophysiology of celiac disease. In susceptible individuals, gluten-containing foods are digested, ...

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Pathophysiology of celiac disease. In susceptible individuals, gluten-containing foods are digested, and gluten moves between the intestinal cells into the space below them. Here, tissue transglutaminase (TTG) deamidates gluten, creating peptides that are efficiently presented to CD4 T cells by HLA-specific antigen-presenting cells (APCs). Cytokine release promotes inflammation and direct toxicity to the intestinal cells. Additional B-cell expansion produces autoantibodies against TTG, endomysium (EMA), and gliadin.
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