Immune Dysregulation and Pediatric Gastrointestinal Disorders Jeremiah Levine, MD, Joseph Levy, MD, Leora Bernstein, CPNP, Nicole Silber, RD, Abha Kaistha, MD, Neha Malhotra, MD, Libia Moy, MD
Foreword: Immune Dysregulation and Pediatric Gastrointestinal Disorders The remarkable anatomy and physiology of the gastrointestinal (GI) tract is extremely well suited to the performance of the critical dual functions of digestion/nutrient absorption and immune protection. With respect to absorption, we are all quite familiar with the importance of the massive surface area provided by the villous architecture of the gut. The unique architecture of the gut is also key in facilitating immune function by providing the physical mucosal barrier, the production of antimicrobial compounds, and specialized immune responses.1 The GI tract accommodates the largest collection of immune cells in the body.1 This latter fact is not so surprising when one considers that, as a major point of interface with the outside world the GI tract must simultaneously identify which orally introduced antigens are benign and should trigger oral tolerance responses and which antigens are potentially harmful and require an inflammatory response. Most of the time, these complex and continuous functions proceed flawlessly; however, on occasion either the tolerogenic or inflammatory response may go awry. Problematic immune system responses in the GI tract, as elsewhere in the body, may take the form of an autoimmune
Curr Probl PediatrAdolesc Health Care, December 2014
reaction, an overactive inflammatory response, or a maladaptive tolerogenic response. Over the past several decades, much has been learned about the role of immune dysregulation in the development of GI disorders. In this month’s issue, Dr. Jeremiah Levine and his colleagues provide us with an in-depth examination of 4 GI disorders in which immune dysregulation plays a central role: celiac disease, inflammatory bowel disease, eosinophilic esophagitis, and autoimmune hepatitis. The articles focus not only on the immunologic aspects, but also address epidemiology, clinical features, management, and prognosis. I am sure you will find that this month’s issue will provide you with a sophisticated and current understanding of the immunologic mechanisms and clinical management of these disorders. Happy reading!
Reference 1. Mason KL, Huffnagle GB, Noverr MC, Kao JY. Overview of gut immunology. Advances in Experimental Medicine and Biology. In: Huffnagle GB, Noverr MC, eds. GI Microbiota and Regulation of the Immune System, v. 635. Landes Bioscience and Springer Science þ Business Media, 2008.
Arthur H. Fierman, MD
321
Foreword: Immune Dysregulation and Pediatric Gastrointestinal Disorders The remarkable anatomy and physiology of the gastrointestinal (GI) tract is extremely well suited to the performance of the critical dual functions of digestion/nutrient absorption and immune protection. With respect to absorption, we are all quite familiar with the importance of the massive surface area provided by the villous architecture of the gut. The unique architecture of the gut is also key in facilitating immune function by providing the physical mucosal barrier, the production of antimicrobial compounds, and specialized immune responses.1 The GI tract accommodates the largest collection of immune cells in the body.1 This latter fact is not so surprising when one considers that, as a major point of interface with the outside world the GI tract must simultaneously identify which orally introduced antigens are benign and should trigger oral tolerance responses and which antigens are potentially harmful and require an inflammatory response. Most of the time, these complex and continuous functions proceed flawlessly; however, on occasion either the tolerogenic or inflammatory response may go awry. Problematic immune system responses in the GI tract, as elsewhere in the body, may take the form of an autoimmune
Curr Probl PediatrAdolesc Health Care, December 2014
reaction, an overactive inflammatory response, or a maladaptive tolerogenic response. Over the past several decades, much has been learned about the role of immune dysregulation in the development of GI disorders. In this month’s issue, Dr. Jeremiah Levine and his colleagues provide us with an in-depth examination of 4 GI disorders in which immune dysregulation plays a central role: celiac disease, inflammatory bowel disease, eosinophilic esophagitis, and autoimmune hepatitis. The articles focus not only on the immunologic aspects, but also address epidemiology, clinical features, management, and prognosis. I am sure you will find that this month’s issue will provide you with a sophisticated and current understanding of the immunologic mechanisms and clinical management of these disorders. Happy reading!
Reference 1. Mason KL, Huffnagle GB, Noverr MC, Kao JY. Overview of gut immunology. Advances in Experimental Medicine and Biology. In: Huffnagle GB, Noverr MC, eds. GI Microbiota and Regulation of the Immune System, v. 635. Landes Bioscience and Springer Science þ Business Media, 2008.
Arthur H. Fierman, MD
321
