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Allogeneic Hematopoietic Stem Cell Transplantation May Restore Gluten Tolerance in Patients With Celiac Disease

Ciccocioppo, Rachele*; Bernardo, Maria Ester; Russo, Maria Luisa*; Vanoli, Alessandro; Franco, Carla; Martinetti, Myriam§; Catenacci, Laura||; Giorgiani, Giovanna; Zecca, Marco; Piralla, Antonio#; Baldanti, Fausto#; Locatelli, Franco; Corazza, Gino Roberto*

Journal of Pediatric Gastroenterology & Nutrition: April 2013 - Volume 56 - Issue 4 - p 422–427
doi: 10.1097/MPG.0b013e318276a6a7
Original Articles: Gastroenterology

ABSTRACT: We report on 2 patients affected by both celiac disease (CD) and β-thalassemia major who underwent successful myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for the latter condition. After HSCT, the introduction of a gluten-containing diet did not cause the reappearance of clinical, serological, and histological markers of CD in up to 5 years of follow-up. After transplantation, in both patients, dendritic cells and regulatory FoxP3+T cells showed a recovery of normal values and no proliferative T-cell response upon gliadin stimulation was found. These data suggest that allogeneic HSCT may lead to induction of gluten tolerance in patients with CD.

*Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia

Dipartimento di Ematologia ed Oncologia, IRCCS Ospedale Pediatrico Bambino Gesù, Roma

Dipartimento di Scienze Pediatriche e Patologia Umana ed Ereditaria, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia

§Servizio Immuno-Trasfusionale, Fondazione IRCCS Policlinico San Matteo

||Laboratorio Immunologia e dei Trapianti - Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo

Onco-Ematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo

#SS Virologia Molecolare SC Virologia e Microbiologia, Fondazione IRCCS Policlinico San Matteo, Italy.

Address correspondence and reprint requests to Rachele Ciccocioppo, MD, Centre for the Study and Cure of Coeliac Disease, Clinica Medica I, IRCCS Policlinico San Matteo Foundation, Piazzale Golgi, 19, 27100 Pavia, Italy (e-mail: rachele.ciccocioppo@unipv.it).

Received 12 July, 2012

Accepted 27 September, 2012

Drs Locatelli and Corazza participated equally in this study and must be considered last authors.

This work was supported in part by a grant from Fondazione Celiachia Italia, project Studio di possibili fattori ambientali e sviluppo di nuove strategie terapeutiche nelle complicanze della malattia celiaca, to G.R.C. This work was also partly supported by grants from MIUR (Ministero dell’Istruzione, dell’Università e della Ricerca, Progetti di Rilevante Interesse Nazionale, PRIN), from Associazione Italiana per la Ricerca sul Cancro (AIRC), from Ospedale Pediatrico Bambino Gesù, Roma, and from the special project “5 per mille” from AIRC to F.L.

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN