Celiac Disease and Pediatric Type 1 Diabetes: Diagnostic and Treatment Dilemmas

Both Type 1 Diabetes (T1D) and celiac disease (CD) result from a complex interplay between genetic susceptibility and environmental exposure. CD is an autoimmune enteropathy characterized by immune-mediated damage to the small intestinal mucosa triggered by ingestion of gluten, a protein complex found in wheat, rye, and barley [1, 2]. CD and T1D have common autoimmune origins. Both are associated with the major histocompatibility complex class II antigen DQ2 encoded by the alleles, DQA1*501 and DQB1*201, thus providing a common genetic basis for disease expression [3, 4]. Recent work has also revealed 7 shared non-HLA loci associated with CD and T1D including RGS1 on chromosome 1q31, IL18RAP on chromosome 2q12, TAGAP on chromosome 6q25, PTPN2 on chromosome 18p11, CTLA4 on chromosome 2q33, SH2B3 on chromosome 12q24, and a 32-bp insertion-deletion variant on chromosome 3p21 [3]. This shared genetic basis is strongly suggestive of a common etiology for both conditions. An increasing body of evidence derived from animal models of T1D as well as human studies [5] suggests that T1D and CD share many causative genetic and environmental factors and highlights the emerging role of dietary antigens in T1D development. This "intestine-diabetes" link supposes that consumption of gluten, alone or acting synergistically with local microbial factors, results in altered gut permeability and mucosal immunity which may predispose the development of T1D [6]. Further insights into our understanding of T1D and other autoimmune conditions will likely be forthcoming through this line of research examining the impact of environmental triggers, altered immune reactivity, and abnormal intestinal permeability.Most estimates put the prevalence of CD at close to 1% of the general population [7–10], and recent evidence suggests that serologic prevalence rates have increased fourfold in the past 50 years [11]. CD is also a global health condition that affects both developing and developed nations