Effect of Addition of Short Course of Prednisolone to Gluten-Free Diet on Mucosal Epithelial Cell Regeneration and Apoptosis in Celiac Disease: A Pilot Randomized Controlled Trial
Digestive Diseases and Sciences, 07/18/2012Shalimar PD et al.
Apoptosis takes place in mucosal epithelium in celiac disease. Addition of short course of prednisolone suppresses apoptosis rapidly. However, it also suppresses epithelial regeneration; hence, if used, it should be withdrawn after an initial short course.
Thirty–three treatment–naïve patients with celiac disease were randomized to either gluten–free diet (GFD, n=17) or GFD + prednisolone (1 mg/kg for 4 weeks, n=16).
Duodenal biopsies were taken at baseline and at 4 and 8 weeks posttreatment.
Six patients with functional dyspepsia were recruited as controls.
All these biopsies were stained for markers of intrinsic apoptotic pathway (AIF, H2AX, p53), common apoptotic pathway (CC3, M30), apoptotic inhibitors (XIAP, Bcl2), and epithelial proliferation (Ki–67).
Apoptotic (AI) and proliferation indices (PI) were compared.
At baseline duodenal biopsies, the end apoptotic products H2AX and M30 were significantly increased.
In comparison with those treated with GFD alone, after 4 weeks of GFD + prednisolone treatment, some markers of both intrinsic and common apoptotic pathways showed rapid decline.
After prednisolone withdrawal, there was overexpression of H2AX, CC3, and p53 in the latter group.
In comparison with those treated with only GFD, patients treated with prednisolone showed suppression of mucosal PI, which started rising again after withdrawal of prednisolone.
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