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,  Clinical Article

Shalimar 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 However, it also suppresses epithelial regeneration; hence, if used, it should be withdrawn after an initial short course.

Methods
  • 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.

Results
  • 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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