Parallels between Pathogens and Gluten Peptides in Celiac Sprue

Pathogens are exogenous agents capable of causing disease in susceptible organisms. In celiac sprue, a disease triggered by partially hydrolyzed gluten peptides in the small intestine, the offending immunotoxins cannot replicate, but otherwise have many hallmarks of classical pathogens. First, dietary gluten and its peptide metabolites are ubiquitous components of the modern diet, yet only a small, genetically susceptible fraction of the human population contracts celiac sprue. Second, immunotoxic gluten peptides have certain unusual structural features that allow them to survive the harsh proteolytic conditions of the gastrointestinal tract and thereby interact extensively with the mucosal lining of the small intestine. Third, they invade across epithelial barriers intact to access the underlying gut-associated lymphoid tissue. Fourth, they possess recognition sequences for selective modification by an endogenous enzyme, transglutaminase 2, allowing for in situ activation to a more immunotoxic form via host subversion. Fifth, they precipitate a T cell–mediated immune reaction comprising both innate and adaptive responses that causes chronic inflammation of the small intestine. Sixth, complete elimination of immunotoxic gluten peptides from the celiac diet results in remission, whereas reintroduction of gluten in the diet causes relapse. Therefore, in analogy with antibiotics, orally administered proteases that reduce the host's exposure to the immunotoxin by accelerating gluten peptide destruction have considerable therapeutic potential. Last but not least, notwithstanding the power of in vitro methods to reconstitute the essence of the immune response to gluten in a celiac patient, animal models for the disease, while elusive, are likely to yield fundamentally new systems-level insights

Síndrome de De Clèrambault: uma revisão bibliográfica The De Clèrambault's syndrome: a bibliographic revision

A síndrome de De Clèrambault (ou erotomania) consiste na convicção delirante, por parte do paciente, de que alguém de posição social mais elevada o ama. Acredita-se que privação sexual seja um fator psicodinâmico importante no desenvolvimento dessa condição, mas fatores orgânicos relacionados com sua etiologia continuam sendo investigados. Pretende-se, com este estudo, revisar o que a literatura médica traz de mais relevante sobre essa doença e suas causas. Para tanto, foram consultadas as bases de dados MEDLINE e LILACS, e os trabalhos mais adequados ao propósito da revisão foram examinados. Constata-se que a erotomania é pouco divulgada na literatura científica, podendo não ser tão rara quanto atualmente se propõe. A maior parte de sua explicação etiológica é pautada em bases psicodinâmicas pertinentes, sem, contudo, relações comprovadas de causalidade com seu quadro clínico. O avanço nas pesquisas neurobiológicas poderá trazer maior precisão ao diagnóstico e ao tratamento dos pacientes erotomaníacos.<br>De Clèrambault's syndrome (or erotomania) consists in a delusional conviction, by the patient, in which someone of higher social status has fallen in love with him or her. Sexual privation can be an important psychodinamic factor on the development of this condition, but organic factors related to its genesis continue on investigation. This study revises the most important aspects that the literature brings us about this disease and its causes. The databases MEDLINE and LILACS have been consulted, and the most appropriate articles were examined. It is established that erotomania is not much found in the scientific literature, and, probably, it isn't as rare as it has been proposed. The major part of its etiologic explanation is based on psychodinamic factors, without, however, confirmed relation of cause with its clinic presentation. The progress in the neurobiologic researches will improve, perhaps, the accuracy of diagnose and treatment of these patients