Indigenous gut microbiota and probiotics in paediatric coeliac disease

Abstract

Coeliac disease (CD) is the commonest immune-mediated enteropathy characterized by a permanent intolerance to cereal gluten proteins. This disease can present at any age with a variety of clinical features, but typical cases often do so in early childhood with small intestinal injury and signs of malabsorption. CD aetiology involves genetic, immunologic and environmental factors. The ingestion of gluten is responsible for CD symptoms and signs. Epidemiological and clinical data also suggest that other environmental factors can contribute to the risk of CD development, including the pattern of infant nutrition and the incidence of infections in early life. Breast-feeding seems to exert a protective role against CD development and greatly influence the gut microbial composition. Indigenous gut microbes are thought to play pivotal roles in the development of the gut barrier function and oral tolerance to dietary antigens. Early exposure to a beneficial microbiota is related to a lower incidence of diverse immune-related diseases (e.g. atopic and autoimmune diseases). Alterations in the composition of the gut microbiota have also been associated with CD presentation in children. These evidences suggest that a balanced composition of the gut microbiota or the presence of specific beneficial bacteria might protect against CD. In this scenario, it can be hypothesised that the administration of probiotics and/or prebiotics in early life could help to regulate the intestinal permeability limiting the access of antigens to the submucosa and contribute to the regulation and fine-tuning of the immune system leading to oral tolerance to gluten.