Tissue destruction and healing in Celiac Disease

乳糜泻的组织破坏和愈合

• 批准号: 10518839
• 负责人: Luis Bruno Barreiro
• 金额: $ 242.63万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518839
• 关键词: Activities of Daily Living; Address; Adult; Affect; Autoimmune; Biochemical; Biological; Bone Diseases; Celiac Disease; Cells; Cellular biology; Chemistry; Child; Childhood; Cholesterol; Clinical; Clinical Research; Communities; Complex; Consumption; Data; Data Analyses; Data Set; Defect; Development; Diet; Digestive System Disorders; Disease; Duodenum; Epithelial; Epithelial Cells; Family member; Genetic; Gluten; Gluten-free diet; Guide prevention; HLA-DQ2; HLA-DQ8 antigen; Health; Heterogeneity; Human; Immune; Immune system; Immunity; Immunologics; Immunology; Individual; Inflammatory; Informatics; Information Resources; Institution; Interferon Type II; International; Intervention; Intestinal Mucosa; Intestines; Investigation; Iron; Knowledge; Link; Lipids; Lymphoma; Malignant Neoplasms; Mediating; Medical; Metabolic; Metadata; Metagenomics; Mission; Molecular; Monitor; Mucous Membrane; National Institute of Diabetes and Digestive and Kidney Diseases; Nutrient; Organoids; Pathogenesis; Patient Care; Patients; Population; Preventive; Process; Publications; Research; Resources; Role; Sampling; Science; Severities; Small Intestines; Small intestine mucous membrane; Symptoms; T-Lymphocyte; Testing; Tissue Model; Tissues; Villous Atrophy; Vitamins; Work; base; biobank; cell type; clinical care; clinical heterogeneity; clinical phenotype; cohort; data management; dietary; follow-up; gene expression variation; healing; human disease; improved; intestinal epithelium; knowledge base; metabolic phenotype; metabolomics; microbial; microbiome; microbiota; mucosal microbiota; multiple omics; non-invasive monitor; novel therapeutic intervention; novel therapeutics; pediatric patients; personalized approach; personalized care; precision medicine; precision medicine clinical trials; predictive modeling; tool; treatment choice; user-friendly; web platform

PROJECT SUMMARY Celiac disease (CeD) is a complex T cell-mediated enteropathy induced by dietary gluten in HLA-DQ2+ and/or HLA-DQ8+ individuals, which currently affects 1% of the global population. A gluten-free diet (GFD) is, to this date, the treatment of choice for CeD. However, 50% of CeD patients are unable to effectively adhere to a diet that sustainably excludes gluten, with many patients suffering from inadvertent gluten exposure. Moreover, over 30% of CeD patients have persistent high symptom burdens, resulting from continued mucosal damage, despite adhering to a GFD. Persistent mucosal damage on a GFD is associated with several severe complications, including malignancies, especially lymphomas and bone diseases. In addition, patients with active CeD display a wide range of clinical presentations, including metabolic defects (vitamins, iron, and cholesterol) that are not correlated to the degree of tissue damage. Although much progress has been made in understanding CeD, major gaps remain, notably regarding the biological mechanisms involved in different clinical presentations and the inconsistent healing process. For instance, it is poorly understood why, independently from the degree of villous atrophy, certain patients display nutrient and lipid deficiencies, whereas others have normal levels of vitamins, cholesterol, and iron. Furthermore, while there is evidence for a role of the microbiome in CeD, we lack information on small-intestinal mucosal microbiota in human CeD (which is more likely to have metabolic effects and directly interact with the immune system). Finally, we have little knowledge about interactions between gluten, intestinal epithelial cells (IECs), immune cells, and the microbiota, and how they are linked to the different CeD clinical phenotypes. Our RC2 proposal will test the hypothesis that CeD is a heterogeneous disorder, while attempting to define interactions between IECs, microbiota, immune system, and genetics that underlie differences in clinical presentation, severity of tissue destruction, and the ability to heal. It will also address critical gaps in our understanding of CeD pathogenesis and clinical presentations, and develop tools for non-invasive monitoring of CeD patients. We have assembled a team of internationally recognized experts in the field of CeD, epithelial cell biology, mucosal immunology, microbiome, and chemistry. The RC2 proposal is anchored around multi-omics studies performed in the context of cross-sectional and interventional gluten challenge and de-challenge studies, on 445 well-characterized adult and pediatric patients. The proposed specific aims are: 1) Developing an approach to precision medicine in CeD; 2) Deciphering the mechanisms associated with tissue destruction and healing in CeD, 3) Developing non-invasive tools for monitoring CeD patients, and 4) Developing research resources for the scientific and medical community to advance patient care as well as discovery-based and hypothesis-generating science. This application aims to generate the much- needed knowledge base and resources to further our understanding of CeD pathogenesis and its heterogeneity, improve individualized patient care and follow-up, and develop new therapeutic and preventive targets.

项目摘要 腹腔疾病（CED）是HLA-DQ2+和/或的复杂T细胞介导的饮食麸质诱导的肠病 HLA-DQ8+个人目前影响全球人口的1％。无麸质饮食（GFD）是 日期，CED选择的治疗方法。但是，50％的CED患者无法有效遵守饮食 可持续地排除了面筋，许多患者患有无意的面筋暴露。而且，结束了 30％的CED患者有持续的高症状负担，但由于持续的粘膜损伤，尽管 坚持GFD。 GFD对GFD的持续粘膜损伤与几种严重的并发症有关， 包括恶性肿瘤，尤其是淋巴瘤和骨骼疾病。此外，具有活性CED显示的患者 多种临床表现，包括非代谢缺陷（维生素，铁和胆固醇） 与组织损伤程度相关。尽管在理解CED方面取得了很多进展，但 仍然存在主要差距，特别是关于不同临床表现涉及的生物学机制和 不一致的康复过程。例如，这是为什么独立于程度独立于 绒毛性萎缩，某些患者表现出营养和脂质缺陷，而其他患者则具有正常水平 维生素，胆固醇和铁。此外，尽管有证据表明微生物组在CED中的作用，但我们缺乏 有关人CED中小智能粘膜微生物群的信息（这更有可能具有代谢作用 并直接与免疫系统相互作用）。最后，我们对面筋之间的相互作用几乎没有任何了解 肠上皮细胞（IEC），免疫细胞和微生物群，以及它们如何链接到不同的CED 临床表型。我们的RC2提案将检验CED是一种异质疾病的假设，而 试图定义IEC，微生物群，免疫系统和遗传学之间的相互作用 临床表现，组织破坏的严重程度和治愈能力的差异。它也会 在我们对CED发病机理和临床表现的理解中解决关键差距，并发展 无创监测CED患者的工具。我们已经组建了一支国际认可的团队 CED，上皮细胞生物学，粘膜免疫学，微生物组和化学领域的专家。 RC2 提案围绕在横截面和介入的背景下进行的多摩斯研究锚定 针对445例特征良好的成人和儿科患者，面筋挑战和促进研究。提议 具体目的是：1）在CED中开发一种精确医学的方法； 2）解密机制 与CED的组织破坏和愈合相关，3）开发用于监测CED的非侵入性工具 患者，以及4）为科学和医学界开发研究资源，以促进患者护理 以及基于发现和假设生成科学的科学。该应用程序旨在生成很多 需要知识基础和资源，以进一步了解CED发病机理及其异质性， 改善个性化的患者护理和随访，并开发新的治疗和预防靶标。