Audio Transcript Auto-generated
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today, I'm going to be talking about celiac disease and
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the microbiome.
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I was diagnosed with celiac disease almost 10 years ago,
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and it was really interesting to learn about how microbiology
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plays a role in a disease that I deal with
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every single day.
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Okay, so what is celiac disease?
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It is a T cell mediated autoimmune disease that is
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thought to be triggered by gluten consumption.
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When someone with celiac disease consumes gluten, there's a release
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of pro inflammatory side kinds such as I Fn Gammon
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and I'll 15, which activates CIDA toxicity of intra epithelial
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lymphocytes. This ultimately leads to damage of the epithelium of
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the small intestine.
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Symptoms of celiac disease are actually very wide ranging, but
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the most common include abdominal pain, diarrhea, abdominal distension and
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anemia. The world wide prevalence of celiac disease ranges between
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1 to 2% of the general population.
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However, celiac disease is thought to be widely under diagnosed
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due to its wide ranging and subtle symptoms, and may
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actually be greater than 1 to 2% of the general
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population. When celiac disease was first discovered in the 19
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fifties, it was thought that a genetic component was the
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main cause of disease manifestation.
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This included the H l E Gina types H L
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a G Q two and ordered Q A half load
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types. However, further investigation has found that approximately 30 to
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40% of the population carries this h l A.
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Genotype. Therefore, there had to have been a missing piece
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between those with the H L A genotype and those
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who eventually developed celiac disease.
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Recent studies have started to evaluate the role of the
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MICROBIOTA as the connection between genetics gluten and environmental factors
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leading to celiac disease.
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Studies have gut microbiota of celiac patients have shown a
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decrease in the overall populations of beneficial bacterial species, including
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lactobacillus and bifida bacterium.
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Additionally, thes studies have shown increases in what we consider
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to be bad gut bacteria, including bacteria ove eighties bacteria.
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This previous and bacterias uniforms us.
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These fluctuations in the gut microbiota has led to a
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phenomenon known as intestinal dis bio sis, which is now
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highly correlated with the development of celiac disease.
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In those who have the H.
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L. A genotype, there is also thought to be environmental
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factors that can lead to changes in the gut Microbiota.
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These include birth gestational age type of delivery.
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So vaginal versus a C section, intestinal infections and antibiotic
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exposure in a normal gut Microbiota, we have intestinal bacteria
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that helped to regulate pro and anti inflammatory processes.
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However, intestinal disc bio cisl, EADS toe less effective regulation
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of these inflammatory processes.
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This ultimately leads to the breakdown of the tight tongue
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tight junction barriers of the epithelium.
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When gluten has entered the body, it is broken down
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into immuno toxic glide and peptides which are then able
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across the epithelium.
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Due to those broken down junctions here, they're able to
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interact with T lymphocytes, macrophages and neutrophils, which lead to
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an innate immune system response and systemic inflammation.
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Okay, In this figure, we see a visual representation of
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this process where we have a balanced healthy gut, microbiome
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versus a gut microbiome in dis bio sis and how
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it leads to a gluten specific immune response.
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Things that can cause dis bio sis of the gut
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include infections or antibiotics, which cause changes in the tight
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junctions of the intestinal mucosa.
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Enhanced exposure of the gluten peptides to immune cells ultimately
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leads to an increased immune response and gluten specific immune
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responses in the future.
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The two main methods for diagnosis of celiac disease include
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blood serology and intestinal biopsy.
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Blood serology evaluates for a quantitative number of trans glue.
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Tammi Neitz antibodies in the blood Endoscopy with biopsy is
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performed to evaluate tissue samples for crypt epithelial hyperplasia, ville
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I flattening or atrophy and intra epithelial lymphocytes, most often
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using a formal in fixative.
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So here we can see an example of a tissue
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slide obtained from a biopsy.
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On the left, we can see a normal duodenal mucosa
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versus the mucosa of someone with celiac disease on the
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right, where you can visualize the atrophy of the ville
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I and the endothelial layers, allowing for the passage of
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Blyden into the immune cells.
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The traditional and currently on lee treatment for celiac disease
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currently is a strict gluten free diet, removing the triggering
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source of the inflammatory process.
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So in this case, gluten leads to symptomatic improvement in
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most patients.
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However, recent studies have begin evaluating the potential for probiotic
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treatment of celiac disease because a gluten free diet in
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and of itself does not completely restore the gut.
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Microbiota, therefore, providing additional beneficial bacteria to the gut could
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deal radically reversed the effects of intestinal disc bio sis.
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An example of this was recently shown in rats where
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befit oh bacterium Long Um, administration was founded to decrease
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the production of inflammatory cited kinds and T cells.
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Probiotic use for treating celiac disease has not yet been
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studied in human patients.