Mucosal immunology, eosinophilic esophagitis, and other intestinal inflammatory diseases - 11/08/11

Doi : 10.1016/j.jaci.2009.11.037

Dan Atkins, MD ^a,^b,^d, Glenn T. Furuta, MD ^a,^b,^c,^d,^⁎
^a Department of Pediatrics, National Jewish Health, the Children’s Hospital, Denver, Aurora, Colo
^b Department of Pediatrics, University of Colorado Medical School, Denver, Aurora, Colo
^c Section of Pediatric Gastroenterology, Hepatology and Nutrition, the Children’s Hospital, Denver, Aurora, Colo
^d Gastrointestinal Eosinophilic Diseases Program, National Jewish Health, the Children’s Hospital, Denver, Aurora, Colo

Reprint requests: Glenn T. Furuta, MD, Pediatric Gastroenterology, the Children’s Hospital, Denver, 13123 East 16th Ave B290, Aurora, CO 80045.

Abstract

The gastrointestinal mucosa constitutes the largest host-environment interface of the body. It uses both innate and adaptive immune mechanisms to provide protection from the diverse onslaught of foods, microbes, and other ingested products. The innate immune system is genetically encoded and evolutionarily ancient, possesses no memory, and lacks diversity. In contrast, the adaptive immune system is quite diverse, develops memory, and undergoes expansion after stimulation. The gastrointestinal mucosa is charged with the difficult task of mounting protective responses against invading microorganisms while simultaneously maintaining an overall state of nonresponsiveness or tolerance to innocuous substances, such as commensal bacteria and food antigens. Perturbation or malfunction of these complex protective mechanisms results in diseases, such as inflammatory bowel diseases, celiac disease, or eosinophilic gastrointestinal diseases.

Le texte complet de cet article est disponible en PDF.

Key words : Mucosal immunity, eosinophilic esophagitis, eosinophilic gastrointestinal diseases

Abbreviations used : DC, EGID, EoE, FAE, Foxp3, GALT, IBD, IEL, LP, M, NOD, PP, TCR, Treg

Plan

Overview of gut-associated lymphoid tissue

Anatomy of GALT

Innate mechanisms of defense

Induction of a mucosal immune response

Diseases

Inflammatory bowel diseases

Celiac disease

Eosinophilic gastrointestinal diseases

Summary

Disclosure of potential conflict of interest: D. Atkins has received research support from the National Institutes of Health Consortium of Food Allergy Research. G. T. Furuta is a consultant for Meritage Pharma, has received research support from the American Gastroenerological Association and the National Institutes of Health, and has provided expert witness testimony on the subject of eosinophilic esophagitis.