INTRODUÇÃO: A Doença Celíaca pode ser definida como uma intolerância permanente ao glúten e proteínas relacionadas, em indivíduos geneticamente susceptíveis, com lesão não específica, porém característica da mucosa do intestino delgado e que apresenta melhora clínica e histológica com a dieta específica. A recente disponibilidade de testes sorológicos que demonstram alta sensibilidade e especificidade permitiu perceber que a Doença Celíaca evidencia-se mais prevalente do que antes imaginado. A utilização do anticorpo antiendomísio IgA (AAE) e do anticorpo anti-transglutaminase tecidual IgA(tTG) viabilizou a realização de estudos de prevalência em doadores de sangue. O objetivo geral dessa pesquisa visa estimar a prevalência da Doença Celíaca em adultos na cidade de São Paulo, através da investigação de marcadores sorológicos em doadores voluntários em banco de sangue. São Paulo representa uma das maiores metrópoles do mundo e a maior cidade do Brasil, sendo um centro urbano com grande variabilidade étnica e um importante pólo de migração interna, aumentando ainda mais a miscigenação da sua população, o que constitui uma fonte de estudo importante para a previsão de prevalência da doença celíaca em nosso país. O objetivo específico propõe correlacionar essa prevalência com a raça/cor dos doadores de sangue, visto que mantidos os fatores genéticos e ambientais, a prevalência da doença celíaca parece ser a mesma, independentemente da região de residência. METODOLOGIA: Aplicação de questionário demográfico, investigação de sintomas e inquérito sobre ancestralidade, aplicados aos doadores, em um total de 4000 voluntários. Foi realizado em toda a amostra o teste sorológico antitransglutaminase IgA, bem como o teste sorológico com anticorpos IgA antiendomísio. Como o padrão ouro na análise da Doença Celíaca ainda é a biópsia do intestino delgado, o diagnóstico foi confirmado com a realização de endoscopia digestiva alta, com biópsia de duodeno e avaliação dos fragmentos com base nos critérios de Marsh modificado por Oberhuber. RESULTADOS: A idade média dos doadores foi de 31 anos, com 1817 do gênero feminino e 2183 masculino. Quanto à ancestralidade, 29% referiram ascendência européia. Dos 4000 testes, houve concordância dos exames em 11 casos, além de 10 com tTG positivo mas sem correlação com AAE e 3 casos apresentando AAE positivo isoladamente. No exame histopatológico, houve confirmação diagnóstica com achados de atrofia de vilos em 14 casos. CONCLUSÃO: Na cidade de São Paulo a prevalência da Doença Celíaca em doadores de sangue comprovada por biópsia é de no mínimo 1:286, semelhante aos de países europeus e Estados Unidos / BACKGROUND: Celiac disease is a permanent enteropathy caused by the ingestion of gluten and leads to an immunologically mediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. More recently, several serological population screenings have shown that the prevalence of the disease is more common than previously imagined. Sao Paulo city is one of the biggest cities in the world, with a large population and with an important history of migratory flow from other countries, mainly European ones, and from other Brazilian cities, also with an important miscegenation. Since Sao Paulo city can be thought as a reflection of ethnic and social characters of the Brazilian population, we have decided to study the prevalence of celiac disease in Sao Paulo city. The aim of the present study was to assess the prevalence of unrecognized adult celiac disease in Sao Paulo and correlate it with further information about ancestry of the population studied. METHODS: We have measured the prevalence of celiac disease by means of a survey of serum markers (IgA transglutaminase antibody-guinea pig and IgA endomysium antibody-human umbilical cord) in 4,000 volunteers donors in the central Blood Bank in Sao Paulo, Pro-Sangue Foundation. The antibody-positive subjects were asked to undergo small-bowel biopsy. RESULTS: There were 1817 female and 2183 male with mean age of 31 years. In the ancestry evaluation of the 4,000 volunteers, we had 68% subjects with Brazilian origin and the remaining from other countries, mainly Italy, Portugal, Spain, and Germany. Of the 4,000 subjects, twenty-four subjects had positive tests, with results of the two antibody tests concordant or not. Ten subjects were positive for IgA-class tissue transglutaminase only. Most donors diagnosed with celiac disease were asymptomatic and when symptomatic the most common symptoms were flatulence and constipation. So far, in 21 positive patients, duodenal biopsies were performed and in 14 patients the diagnosis of celiac disease was confirmed (Marsh criteria modified for Oberhuber). CONCLUSION: Among apparently healthy blood donors, the prevalence of celiac disease is at least 1: 286 donors, similar to that seen in the United States and Europe

The Dissertation deals with educational materials for patients with celiac disease. It describes general requirements for teaching materials and the didactical principles suitable for educational materials for patients with celiac disease. It presents a draft criteria for assessment of web sites intended for people suffering of celiac disease. Five Czech, as well as foreign Internet-based resources, have been selected and assessed for compliance with the criteria given by technical properties, contents, page structures, criteria evaluating credibility of the sites and educational criteria. All the sites assessed can be used for education of patients with celiac disease, but they are rather information sites with a low content of educational characteristics.

This thesis deals with the gluten-free diet and its possible enrichment. It is divided into two parts. The first part includes chapters such as history of gluten-free diet, basics of a gluten free diet, the first step in the introduction of a gluten-free diet, gluten-free food labeling legislation and the use of alcohol on a gluten-free diet. The practical part is focused on enriching the diet celiac patients. I focused on the preparation of bakery products for celiac, I have designed and practically tested recipes gluten-free pizza, buckwheat corpus, gluten-free sourdough seedcake and gluten-free cake with homemade pudding and caramel. The finished gluten-free products were submitted after baking consumers who rated their sensory quality. If necessary, an adjustment was made to the recipe and re-perform sensory evaluation. The prepared products were evaluated positively. Selected coeliacs decided suggested products to include in their diet.

Master of Science / Food Science Institute - Animal Science & Industry / Fadi M. Aramouni, Bean, Scott R. / The biochemical, physical and baking properties of caroubin, the main protein in the carob bean, were characterized. The biochemical properties of caroubin were analyzed using reversed-phase high performance liquid chromatography (RP-HPLC), size exclusion chromatography coupled with multi-angle laser light scattering (SEC-MALS) and micro-fluidics analysis. The physical and baking properties of caroubin were characterized via SE-HPLC, laser scanning confocal microscopy, farinograph mixing, and texture profile analyzer analysis. Using a modified Osborne fractionation method, carob germ flour proteins were found to contain ~32% albumin and globulin and ~68% glutelin with no prolamins detected. When divided into soluble and insoluble protein fractions under non reducing conditions it was found that caroubin contained (~95%) soluble proteins and only (~5%) insoluble proteins. As in wheat, SEC-MALS analysis showed that the insoluble proteins had a greater Mw than the soluble proteins and ranged up to 8x107 Da. These polymeric proteins appeared to play a critical role in protein network formation. Analysis of the physical properties of carob germ protein-maize starch dough showed that the dough’s functionality was dependent on disulfide bonded protein networks, similar to what is found in wheat gluten. When baked into a bread these proteins were shown to have a possible improving affect by decreasing staling in gluten-free breads. This was evident when compared to a gluten-free batter bread, and a wheat bread over a five day period.

Objetivo: estudiar la frecuencia de positividad de las pruebas serológicas en pacientes con biopsias compatible con enfermedad celiaca. Material y métodos: estudio transversal. Se incluyeron pacientes con biopsia duodenal histológicamente compatible con enfermedad celiaca y determinación de anticuerpos antigliadina, antiendomisio y antitransglutaminasa IgA. Definimos como caso de enfermedad celiaca a quienes tuvieran biopsia positiva y anticuerpos antiendomisio y/o antitransglutaminasa positivos. Resultados: 31 pacientes fueron incluidos de los cuales 6 fueron antiendomisio positivo, 5 fueron antitransglutaminasa positivo y antigliadina fue positivo en 14. Por lo tanto de 31 pacientes con cambios histológicos compatibles con enfermedad celiaca sólo 10 tuvieron serología diagnóstica. Sólo uno de los pacientes tuvo positividad tanto para antitransglutaminasa como para antiendomisio. Conclusiones: a) encontramos que la mayoría de biopsias de duodeno con un cuadro histológico sugerente de enfermedad celiaca no se corresponden con serología diagnóstica de esta enfermedad; b) encontramos baja coincidencia en la positividad serológica entre antiendomisio y antitransglutaminasa. / Objective: to study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease. Material and methods: cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a “case” of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies. Results: thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase. Conclusions: a) we have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

Existe un grupo de enteropatía conocidas como AVSN que pueden simular enfermedad celíaca. Objetivo: El objetivo de este estudio es describir los hallazgos histológicos y de inmunohistoquímica en pacientes con enfermedad celíaca y AVSN. Material y métodos: 15 biopsias de pacientes con enfermedad celíaca y 19 biopsias con AVSN fueron reexaminados. Se estudió características histológicas tales como atrofia severa, hiperplasia de criptas, número de células plasmáticas, número de eosinófilos y presencia de neutrófilos. Asimismo, a través de inmunohistoquímica se estudió la presencia de linfocitos CD4, CD8, CD3, CD56. Resultados: Se encontró diferencia significativa en la mayor presencia de hiperplasia de criptas (p=0,0348) y mayor número de células plasmáticas (p=0,0348) en las biopsias de enfermedad celíaca que en las catalogadas como AVSN. El número de linfocitos CD8, CD4, CD56 y su distribución fue similar en ambos grupos. El porcentaje de linfocitos intraepiteliales CD3 positivos (p=0,0144) fue mayor en pacientes con AVSN. Conclusión: Los hallazgos histológicos e inmunohistoquímicos muestran más similitudes que diferencias. La diferencia hallada en nuestro estudio sugiere mayor respuesta inmune humoral en pacientes con enfermedad celiaca que en AVSN. / There is a group of enteropathies recently known as seronegative villous atrophy (SNVA), which can simulate celiac disease. Objective: The aim of this study was to describe histological and immunohistochemical differences between a group of Celiac disease and SNVA patients. Material and methods: Microscopy reexamination and Immunohistochemistry study were performed for a group of 15 celiac patients and 19 SNVA patients. Histological features as severe atrophy, crypt hyperplasia, plasma cells number, eosinophils number, neutrophils presence were studied; CD4, CD8, CD3, and CD56 markers were studied through immunohistochemistry. Results: There was a significant difference between the frequency of observation of crypt hyperplasia (p=0.0348) and plasma cells (p=0.0348) in celiac disease patients than SNVA patients. In celiac disease was bigger. The number and distribution of CD 8, CD4 and CD56 lymphocytes was similar in both groups. The percentage of CD3 positive intraepithelial lymphocytes (p=0.0144) was higher in SNVA. Conclusion: Histological and immunohistochemical evaluation shows more similarities than differences. The differences found in this study suggest more humoral immune response in celiac disease than in SNVA.

8 Abstract Introduction: Celiac disease is indentified as the loss of oral tolerance to gluten, it is an organ-specific autoimmune disease in which both, adaptive and innate immunity participate. Monocytes are important part of immune system; they have many functions and express very diverse membrane receptors including Toll-like receptors (TLRs). TLRs are involved in the innate immune response, specifically TLR2 and TLR4 are crucial for recognition of bacterial components and TLR7 recognizes virus's ssRNA. Monocytes also produce prolaktin (PRL), which acts as a cytokine that modulates immune responses. To clarify the role of innate immunity and circulating monocytes in pathogenesis of celiac disease, we focused on changes in expression of selected Toll-like receptors (TLR2, TLR4, TLR7), prolactin, some pro- a anti-inflammatory cytokines (TNF-α, IL-6, IL-12, IL-10). We monitored the influence of the SNP - 1149 G/T on the expression of PRL mRNA. Another objective of this work was the introduction and optimization of in vitro methods for cultivation and stimulation of peripheral monocytes. Material and Methods: This pilot study includes 21 patients with celiac disease and 40 healthy controls. For determination of mRNA levels of the studied genes we isolated RNA from monocytes that were isolated by...

Os gânglios pertencentes ao Sistema Nervoso Autônomo (SNA) estão divididos em grupos de acordo com sua localização. Os gânglios celíaco e mesentérico superior são gânglios simpáticos pré-vertebrais. Estes se localizam anteriormente à coluna vertebral e à aorta abdominal ao nível das vértebras T12 a L1. Conectando o Sistema Nervoso Central (SNC), por meio dos nervos esplênico maior e menor, ao Sistema Nervoso Periférico (SNP), formando um emaranhado de nervos denominado plexo nervoso. Ambos participam do controle da motilidade gastrointestinal, sendo assim, estão envolvidos na fisiopatologia dos distúrbios inerentes ao seu território de inervação. Foram dissecados e fixados a solução de formol a 4%, 33 blocos anatômicos de seres humanos contendo a parte abdominal da aorta e o pâncreas, obtidos de 15 indivíduos do gênero masculino e 18 do feminino com idades variando de 20 a 90 anos, divididos em três grupos: Grupo I (jovens - 20 a 40: 3 homens e 4 mulheres); Grupo II (adulto - 45 a 60: 8 homens e 6 mulheres) e Grupo III (idosos - 70 a 90: 4 homens e 8 mulheres), onde avaliou-se aspectos estruturais e ultraestruturais dos gânglios celíacos e mesentérico superior, quanto à sua topografia e componentes microscópicos por meio das colorações de Hematoxilina e Eosina, Tricromo de Masson, Violeta Cresil, Verhoff e Picro-Sirius, observou-se respectivamente, a identificação geral dos componentes ganglionares, fibra elástica e o componente colágeno ganglionar, assim como análises por método de Microscopia Eletrônica de Varredura (MET). Quanto ao aspecto macroscópico os gânglios celíacos foram contados em número de 58, sendo 25 espécimes (86% dos casos) apresentaram-se bilateralmente de formato retangular, 7 (12%) estavam fusionados na linha mediana, e 1 (1,7%) no antímero esquerdo, ambos de aspecto irregular. Relativamente todos pertencentes a este antímero estavam em situação inferior aos do antímero direito. Já o gânglio mesentérico superior, de formato preferencialmente estrelado, ocorreu em 10 espécimes (30%) ele estava situado anteriormente à artéria mesentérica superior, e em 17 (51%), posteriormente a ela, em 3 casos foi encontrado um entrecruzamento de fibras nervosas espessas com presença de corpos celulares espaçados, e em 3 casos (9%), o gânglio não foi encontrado, apenas um emaranhado de feixes com fibras nervosas. Referente a parte qualitativa, notou-se que à medida que o ser humano envelhece há uma diminuição das fibras colágenas do tipo III, passando a predominar fibras do tipo I nos grupos: GII e GIII e quantitativamente, foram analisados 9 gânglios sendo 3 de cada grupo: GI (20-40: 2 homens e 1 mulher); GII (45-60: 3 homens) e GIII (70-90: 3 mulheres), embora não se tenha realizado uma análise estatística a média das áreas dos nervos do GIII foi maior em relação ao GI, por outro lado as áreas dos fascículos nervosos não exibiram diferenças aparentes. A área do corpo neuronal de GI, GII e GIII houve uma progressiva diminuição desse parâmetro nos grupos GII e GIII. O material foi fornecido pelo Sistema de Verificação de Óbito da Capital SP (SVOC-SP/USP) e após a sua coleta as peças foram processadas no Laboratório de Anatomia Funcional Aplicada a Clínica e à Cirurgia (LAFACC) do Departamento de Anatomia do Instituto de Ciências Biomédicas III da Universidade de São Paulo (ICB III USP). O estudo estrutural e ultraestrutural de gânglios simpáticos em humanos abre perspectivas futuras para pesquisas correlacionadas a morfologia e sua função. Os resultados podem ter importância para a neurociência humana, dando embasamento para tratamentos de doenças relacionadas ao trato gastrointestinal (TGI), o que pressupõe grande relevância deste estudo. / The ganglia belonging to the Autonomic Nervous System (ANS) are divided into groups according to their location. The superior celiac and mesenteric ganglia are pre-vertebral sympathetic ganglia. These are located anterior to the vertebral column and to the abdominal aorta at the level of the vertebrae T12 to L1. Connecting the Central Nervous System (CNS), via the major and minor splenic nerves, to the Peripheral Nervous System (SNP), forming a tangle of nerves called the nervous plexus. Both are involved in the control of gastrointestinal motility and are therefore involved in the pathophysiology of the disorders inherent to their territory of innervation. A total of 33 human anatomical blocks containing the abdominal part of the aorta and the pancreas, obtained from 15 male and 18 female subjects with ages varying from 20 to 90 years, divided into three groups: Group I (young - 20 to 40: 3 men and 4 women); Group II (adult - 45 to 60: 8 men and 6 women) and Group III (elderly - 70 to 90: 4 men and 8 women), where structural and ultrastructural aspects of the celiac and mesenteric superior ganglia were evaluated for their topography and microscopic components through the staining of Hematoxylin and Eosin , Masson\'s trichrome, Violet Cresil, Verhoff and Picro-Sirius, the general identification of the ganglionic components, elastic fiber and the ganglionic collagen component, as well as the Scanning Electron Microscopy (MET) method were observed. As to the macroscopic aspect, the celiac ganglia were counted in 58, 25 specimens (86% of the cases) were bilaterally rectangular, 7 (12%) were fused at the median line, and 1 (1,7%) in the antimer left, both of irregular appearance. Relatively all belonging to this antimer were inferior to those of the right antimer. The superior mesenteric ganglion, with a predominantly star-shaped shape, occurred in 10 specimens (30%), located anterior to the superior mesenteric artery, and in 17 (51%), posterior to it, in 3 cases a \"cross-linking\" of and in 3 cases (9%), the ganglion was not found, only a tangle of bundles with nerve fibers. Regarding the qualitative part, it was noticed that as the human being grows older there is a decrease of type III collagen fibers, and type I fibers predominate in the groups: GII and GIII and quantitatively, 9 glands were analyzed, 3 in each group: GI (20-40: 2 men and 1 woman); GII (45-60: 3 men) and GIII (70-90: 3 women), although no statistical analysis was performed the mean of the GIII nerve areas was higher in relation to the GI; on the other hand, the areas of the nerve fascicles showed no apparent differences. The area of the neuronal body of GI, GII and GIII showed a progressive decrease of this parameter in the GII and GIII groups. The material was supplied by the São Paulo State Capital Surveillance System (SVOC-SP / USP) and after its collection the pieces were processed in the Laboratory of Functional Anatomy Applied to Clinic and Surgery (LAFACC) of the Department of Anatomy of the Institute of Biomedical Sciences III of the University of São Paulo (ICB III - USP). The structural and ultrastructural study of sympathetic ganglia in humans opens future perspectives for research correlated with morphology and its function. The results may be important for human neuroscience, giving support to treatments of diseases related to the gastrointestinal tract (GIT), which presupposes great relevance of this study.

Os objetivos desse estudo foram: 1) Padronizar a pesquisa do anti-tTg, comparando-o com o anticorpo antiendomísio (AAE) e 2) Avaliar as interações da tTg com a fibronectina. 49 celíacos e 124 controles com AAE negativo foram avaliados. O AAE foi pesquisado por imunofluorescência indireta e a reatividade contra a tTg e a fibronectina por ELISA in house e com kits comerciais. O antitTg foi positivo em 46,9% e 100% dos celíacos com o ELISA in house e com kits comerciais, respectivamente. A adição de fibronectina não melhorou a sensibilidade do ELISA. Em conclusão: a detecção do antitTg por ELISA apresenta percentual elevado de falso-positivos, não podendo substituir a pesquisa do AAE / The aims of the current study were: to standardize the detection of anti-tTg antibodies, comparing them with antiendomysial antibodies (EMA) and to assess the interaction of tTg with fibronectin. 49 celiac patients and 124 controls were enrolled. EMA was detected by indirect immunofluorescence reaction and tTg and fibronectin reactivity by in house ELISA and with commercially available kits. Seropositivity to anti-tTG was found in 46.9% and 100% of patients by the in house technique and by commercial kits, respectively. Fibronectin addition did not improve the ELISA sensibility. In conclusion, ELISA for anti-tTG detection has a high rate of false positive results and does not replace EMA

Made available in DSpace on 2016-08-10T10:44:18Z (GMT). No. of bitstreams: 1 JULIANA SOUZA E SILVA.pdf: 5512462 bytes, checksum: 6eb9649a41c4fc1234a638bbb53fcf1d (MD5) Previous issue date: 2012-06-14 / This research aimed to develop a process for the manufacture of gluten free cookies which can be ingested by celiac patients. Celiac disease is characterized by the non digestibility of gluten in the small intestine. Gluten is a protein fraction found in wheat, barley, rye and malt. In the world, there are millions of people prevented from consuming different products with gluten. Thus, in this work describes the process to remove gluten from wheat flour, characterization by physic-chemical and technological analysis, optimization formulation of cookies and evaluation of sensory acceptability. Four brands of wheat flour type I obtained in Goiania (A, B, C and D). Was used in this work. The results showed that the best after the process deglutinization was sample C that was choose for to prepare the product. Gluten free-cookies was prepared using flour without gluten, sugar, margarine, eggs, baking powder, vanilla essence and chocolate chips. This formulation was submitted to a 40 member sensory panel to assess the attributes of appearance, texture, flavor and overall acceptance. Generally, the sensory analysis showed overall acceptance was 8,0 ( I like much ) for three attributes (flavor, texture and appearance). With regard to the variable flavor the result was 9 point in the hedonic scale (I like very much). Most members sensory wrote that they to intent to purchase the product. In evaluating the economic viability of the cookie, to verify the sustainability, it was observed that it is possible for patients with celiac disease, as well as the product was free of gluten with much more afford able price compared to existing products on the market reaching the main objective of the research to develop a sustainable product for diets restricted to gluten. / Esta pesquisa teve como objetivo desenvolver uma fórmula de cookie que possa ser consumida por pacientes celíacos. A doença celíaca é caracterizada pela não digestibilidade do glúten no intestino delgado. O glúten é a fração protéica presente no trigo, cevada, centeio e malte. Mundialmente existem milhões de pessoas impedidas em consumir diversos produtos com glúten. Desta forma, neste trabalho desenvolveu-se uma metodologia para retirar o glúten da farinha de trigo, caracterizar por análises físico-químicas e reológicas, aperfeiçoar a formulação dos cookies sem glúten e avaliar a aceitação sensorial. Foram utilizadas quatro marcas de farinhas de trigo especial tipo I, obtidas no comércio de Goiânia/GO (A, B, C e D). A farinha que apresentou melhores características após o processo de desglutinização foi a C, a qual foi utilizada na formulação que teve como base a farinha sem glúten, açúcar, margarina, ovos, fermento, essência de baunilha e gotas de chocolate. A análise sensorial de aceitação evidenciou que o produto foi bem aceito, já que a maioria dos provadores atribuiu média global 8 para os três atributos: sabor, textura e aparência, que na escala hedônica de 9 pontos usada, corresponde à descrição gostei muito . A maioria dos provadores também apresentaram intenção de compra do produto em questão, comprovando a sua boa aceitação. Ao avaliar a viabilidade econômica do cookie sem glúten, para verificação da sustentabilidade, observou-se que o mesmo é viável para portadores de doença celíaca, já que o produto, além de isento de glúten, ficou com o preço bem mais acessível que os produtos existentes no mercado, atingindo o objetivo principal da pesquisa de desenvolver um produto sustentável para dietas restritas ao glúten.