Part 10 Of 12 Part Series: Heart and Lung Symptoms In Undiagnosed Celiac Disease
This is the tenth in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, heart and lung symptoms will be discussed. There are studies, articles, and books identifying an association between CD, cardiac (heart), and pulmonary (lung) symptoms. The pathogenesis is likely due to autoimmune reactions (to ingested gluten), causing inflammation and damage to the cardiopulmonary system, in genetically predisposed individuals (1-39,44,45,61).
Cardiac (Heart) Symptoms
A functional cardiac system is dependent on intact blood vessels, adequate blood supply, intact cardiac nervous system and functional cardiac muscle. Hypothetically, cardiac symptoms may result from auto-antibodies (to ingested gluten and related prolamines) cross-reacting with blood vessels (might inhibit angiogenesis), the cardiac nervous system, or the cardiac muscle. Since we know immune reactions to gluten can affect the nervous system (ex. gluten ataxia or neuropathies) and the muscular system (ex. myopathies), it is reasonable to suspect that these two systems, involved in cardiac health, could be affected. The finding of anti-transglutaminase antibodies in end-stage heart failure and cardiomyopathy increases this possibility. With blood vessels, one study demonstrated angiogenesis was inhibited in the intestine of CD patients and the researchers suspect that impaired angiogenesis could occur in other areas of the body as well. Auto-antibodies have been found around blood vessels in the brain of CD patients, it is plausible to suspect that autoimmune reactions against tissue transglutaminase could occur around the vessels of the heart as well. Associated vasculitis, leading to stenosis, occlusions, or aneurysm of the blood vessels, may add to impaired cardiovascular health in CD (1,7-10,12,13,15-22,44,45,54,57-59,61).
In some individuals with CD, the intestinal villi responsible for absorbing nutrients becomes damaged, creating a flattened mucosal surface (villous flattening). Autoimmune reactions to ingested gluten and related prolamines cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this can cause or add to the severity of the cardiac and pulmonary symptoms (1-3,40-43). Nutrient deficiencies that may affect the cardiac nervous system, cardiac muscle, and the functional structure of the heart and lungs include vitamins A, D, E, K, B complex, amino and fatty acids, calcium, magnesium, phosphorus, copper, electrolytes, iodine, iron, zinc, manganese, selenium, l-carnitine, antioxidants, and inositrol. Examples demonstrating a cardiac impact include thiamine deficiency leading to wet beriberi or acute pernicious beriberi, low electrolytes (or magnesium, calcium) leading to arrhythmias, low iron and B vitamins leading to anemia, or low vitamin K levels affecting protein S or protein C (involved in clotting) possibly leading to a heart attack. The presence of associated antiphospholipid syndrome could increase the risk of clots as well. Hypotension (a cardiac stressor) could result from low protein levels (ex. albumin), low electrolytes, or dehydration especially if diarrhea and vomiting is present. As well, other deficiencies could affect the cardiac structure or nervous system leading to many possible cardiac symptoms (7,11-14,15,42,43,51-53,55,56,59,93,99).
In studies (including case studies), books, and articles, cardiac conditions associated with CD include idiopathic dilated cardiomyopathy (fairly well known association), heart failure, angina, myocardial infarction (heart attack), cardiomegally, pericarditis, myocarditis, arrhythmias, and atrioventricular heart block. ECG and tissue doppler imaging results were mentioned in 2 studies. ECG changes showed prolonged QT-period with ventricular bigeminus in an adult. Doppler imaging of the heart revealed myocardial systolic wave velocity (of the mitral annulus) was low and the left ventricle had subclinical systolic dysfunction (in children) (1,7-10,12,13,15-22,44,45,61). Further research is needed to examine the possible role of CD in other heart conditions.
The good news is that a strict gluten-free diet should effectively eliminate the auto-antibodies leading to better cardiac health in most individuals. There is always a risk though of irreversible permanent damage (7,9,11,12,19,20,22,33,47-49,50-59).
24 years ago, I was diagnosed with mitral valve prolapse. I experienced palpitations which lead to the diagnosis. Approximately, 20 years later, doppler imaging demonstrated that I no longer had this heart condition. Was it misdiagnosed (diagnostic tests are more accurate now) or did a gluten free diet somehow help to correct it?.
Pulmonary (Lung) Symptoms
A functional pulmonary system is reliant on the structural integrity of the lungs, the autonomic nervous system, a healthy heart, and a healthy vascular supply of blood. Hypothetically, pulmonary symptoms may result from auto-antibodies directed at blood vessels (might inhibit angiogenesis), the autonomic nervous system, the cardiac system (as discussed above), or the lung tissue. As mentioned under cardiac symptoms, we know that auto-antibodies can affect nerves, muscle, and vascular tissue, it is reasonable to suspect that the smooth muscle and other lungs tissue along with the autonomic nervous system may be affected in CD (47-50,54).
There are other factors that may affect pulmonary function. The presence of vasculitis (also could cause Wegener’s Granulomatosis), antiphospholipid syndrome, along with protein S and C abnormalities could increase the risk for clots (pulmonary embolus). Conversely, low vitamin K levels, due to malabsorption could lead to diffuse pulmonary bleeding. As well, the presence of anemia (common in CD) may impair the supply of oxygen to the cells causing further distress. If heart failure occurs, pulmonary edema (fluid in the lungs) could also impair oxygen exchange. An additional concern is that chronic tissue damage might increase the risk of lung cancer. Collectively or individually, these factors along with nutrient deficiencies (such as vitamin A deficiency leading to loss of cilia and and mucin in lungs) could lead to a variety of pulmonary symptoms (33,51-59,68).
In studies (including case studies) and articles, pulmonary conditions may include lung infections, lung abscesses, increased susceptibility to tuberculosis, bronchiectasis, pneumonia, pulmonary hemosiderosis, fibrosing alveolitis of the lung, and possibly pneumococcal septicemia. There were a few case studies mentioning an association between cystic fibrosis and CD as well. In one study, cystic fibrosis patients had a higher prevalence of CD than in the general population. The researchers recommended that individuals with cystic fibrosis should be screened for CD (if they live in a population where CD exists). There is evidence that tissue transglutaminase is elevated in cystic fibrosis. Perhaps auto-antibodies (ex. anti-tissue transglutaminase) react to this overproduction and cross-react with the lungs, similar to the response seen in the bowel, brain, and heart of individuals with CD/gluten sensitivities (2-8,14,23-31,45,49,50,60,61).
Further research is needed to examine the cystic fibrosis/CD connection, and possible autoimmune effects with other lung diseases, such as asthma. My mother, daughter, and I all have CD and asthma. I have talked to many others with CD and asthma as well. Could gluten sensitivity be responsible for many other lung diseases as well? More research is needed.
Other Contributing Factors
Other factors that may contribute to cardiopulmonary symptoms include smoking, hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia (associated with CD), renal failure, bleeding (hemorrhage), thyroid disease, trauma, infections, genetics, toxic-metabolic agents, certain medications, poor diet, vitamin deficiency or toxicity, alcoholism, heavy metals, solvents, street drugs, and past gastric or intestinal surgery (leading to deficiencies) (14,15,42,43,46).
Diagnosis
There are a number of tests to consider when diagnosing gluten sensitivities. IgA endomysial antibodies and anti-transglutaminase antibodies are useful blood tests along with an upper endoscopy with multiple biopsies (to investigate intestinal involvement) (1,5,6,152). A 2009 study recommends adding IgG Celiac G+ antibody test along with IgA anti-transglutaminase antibody for screening (147). If the patient has IgA deficiency then IgG tissue transglutaminase antibody test may be helpful. As well, IgG and IgA antigliadin antibodies may be helpful to identify if increased intestinal permeability has allowed gluten (gliadin) to leak in through the tight junctions between the intestinal epithelial cells. This leakage could potentially lead to a gluten sensitivity and with continued exposure potentially CD. Positive IgG and IgA antigliadin antibodies can indicate that a gluten sensitivity exists (1,5,6,45,62-64).
Additional tests are available as well, such as HLA genetic testing, fecal tests, rectal mucosal patch technique (new in Sweden), and saliva tests. (1,62,63,115,146). It is important to explore the presence of nutrient deficiencies as well.
Do You Have Any Of The Above Symptoms?
CD can be present in children that are growing normally so normal growth rate should not be a factor that excludes the possibility of CD (65). Many individuals with undiagnosed CD/gluten sensitivities will have no bowel symptoms. Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (1-3). Therefore, the symptoms in this post could occur in the absence of stunted growth, weight loss, or bowel symptoms.
The presence of cardiopulmonary symptoms as discussed in this post, indicates that you should talk to your MD about tests for gluten sensitivities/CD and tests to rule out other possible causes of your symptoms. Testing for CD/gluten sensitivities is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,62,63,67), and many other health complications that will be discussed in the posts about CD/gluten sensitivity symptoms. It is my hope that if you have cardiopulmonary symptoms you can print out this post complete with medical references to take with you to the MD when you request testing. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.
It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process. Allergy testing, and/or an elimination diet may help you to identify offending foods. Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. A consultation with a Registered Dietitian can provide guidance to ensure all nutritional needs are met. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.
I recommend waiting until CD/gluten sensitivity testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.
Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us. We are all unique!
References
1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc
2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.
3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders
4. F.M. Stevens, C.E. Connolly, J.P. Murray, C.F. McCarthy. Lung Cavities in Patients with Coeliac Disease. Digestion 1990;46:72-80
5. Williams AJ, Asquith P, Stableforth DE. Susceptibility to tuberculosis in patients with coeliac disease. Tubercle. 1988 Dec;69(4):267-74.
6. J F Ludvigsson1,2, J Wahlstrom3, J Grunewald3, A Ekbom2,4, S M Montgomery2,5 Coeliac disease and risk of tuberculosis: a population based cohort study. Published Online First: 17 October 2006. doi:10.1136/thx.2006.059451
Thorax 2007;62:23-28
7. Goel NK, McBane RD, Kamath PS. Cardiomyopathy associated with celiac disease. Mayo Clin Proc. 2005 May;80(5):674-6. http://www.ncbi.nlm.nih.gov/pubmed/15887437
8. Nidhi Narulaa, Pawan Rawalb, Rohit Manoj Kumara and Babu Ram Thapab Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis. Oxford Journals. Journal of Tropical Pediatrics Advance Access published online on November 6, 2009. Journal of Tropical Pediatrics, doi:10.1093/tropej/fmp088. http://tropej.oxfordjournals.org/cgi/content/abstract/fmp088v1
9. Mario Curione, Maria Barbato, Pietro Cugini, Silvia Amato, Silvia Da Ros, Simonetta Di Bona. Association of cardiomyopathy and celiac disease: an almost diffuse but still less know entity. Arch Med Sci 2008; 4, 2: 103–107. http://www.termedia.pl/magazine.php?magazine_id=19&article_id=10658&magazine_subpage=ABSTRACT
10. Lodha, Ankur MD; Haran, Mehandi MD; Hollander, Gerald MD; Frankel, Robert MD; Shani, Jacob MD. Celiac Disease Associated with Dilated Cardiomyopathy. Southern Medical Journal: October 2009 – Volume 102 – Issue 10 – pp 1052-1054.
11. Tarcisio Nota, Elena Faleschinia, Alberto Tommasinia, Alessandra Repettob, Michele Pasottib, Valentina Baldasa, Andrea Spanoa, Daniele Sblatteroc, Roberto Marzaric, Carlo Campanab, Antonello Gavazzid, Luigi Tavazzib, Federico Biagie, Gino Roberto Corazzae, Alessandro Venturaa and Eloisa Arbustinif,* Celiac disease in patients with sporadic and inherited cardiomyopathies and in their relatives. European Heart Journal 2003 24(15):1455-1461; doi:10.1016/S0195-668X(03)00310-5. http://eurheartj.oxfordjournals.org/cgi/content/abstract/24/15/1455
12. M. Curione
, 
, M. Barbatob, F. Viola2b, P. Franciaa, L. De Biasec and S. Cucchiarab Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. Digestive and Liver Disease Volume 34, Issue 12, December 2002, Pages 866-869. http://tinyurl.com/y9hhwjt
13. Ricardo Schmit T De Bem1, 4 
, Shirley Ramos Da Ro Sa Utiyama2, Renato Mitsunori Nisihara2, Jerônimo Antônio fortunato3, josuÉ Augusto Tondo3, Eliane Ribeiro Carmes1, Raquel Almada E. Souza1, Julio CÉsar Pisani1 and Heda Maria Barska Dos Santos Amarante1 Celiac Disease Prevalence in Brazilian Dilated Cardiomyopathy Patients. Journal Digestive Diseases and Sciences Issue Volume 51, Number 5 / May, 2006 http://www.springerlink.com/content/t13467701v3648nu/
14. Ravi Mahadeva,a Christopher Flower,b John Shneersona Bronchiectasis in association with coeliac disease. Thorax 1998;53:527-529; doi:10.1136/thx.53.6.527
15. Tugcin B. Polata,, Nafiye Urgancib, Yalim Yalcina, Cenap Zeybeka, Celal Akdeniza, Abdullah Erdema, Elnur Imanova and Ahmet Celebia Cardiac functions in children with coeliac disease during follow-up: Insights from tissue Doppler imaging. Digestive and Liver Disease Volume 40, Issue 3, March 2008, Pages 182-187. http://tinyurl.com/ydzutq7
16. WEI, L. *; SPIERS, E. +; REYNOLDS, N. ++; WALSH, S. [S]; FAHEY, T. [P]; MACDONALD, T. M. * The association between coeliac disease and cardiovascular disease. Alimentary Pharmacology & Therapeutics. 27(6):514-519, March 15, 2008. http://tinyurl.com/yeyw2aw
17. Siry M, Burges C, Stiens R, Schneider H, Steiff J. [First diagnosis of celiac disease in a 67-year old female patient]. Dtsch Med Wochenschr. 2000 Aug 4;125(31-32):932-6.
18. Loren A. Laine, MD; Kenneth M. Holt, MD. Recurrent Pericarditis and Celiac Disease. JAMA. 1984;252(22):3168.
19. R. Faizallah1, 2 , F. C. Costello1, 2, Frank I. Lee1, 2 and Robin Walker1, 2 Adult celiac disease and recurrent pericarditis. Journal Digestive Diseases and Sciences Volume 27, Number 8 / August, 1982
20. Dawes PT, Atherton ST. Coeliac disease presenting as recurrent pericarditis. Lancet. 1981 May 9;1(8228):1021-2.
21. D. Pratilb, , , M. T. Bardellac, M. Peracchic, L. Porrettia, M. Cardilloa, C. Pagliaric, C. Tarantinoc, E. Della Torrea, M. Scalamognab, P. A. Sianchic, G. Sirchiaa, D. Conte and North Italy Transplant Programme Working Group (NITp)c High frequency of anti-endomysial reactivity in candidates to heart transplant. Digestive and Liver Disease
Volume 34, Issue 1, January 2002, Pages 39-43. http://tinyurl.com/ye75v9p
22. Andrea Frustaci, MD; Lucio Cuoco, MD; Cristina Chimenti, MD; Maurizio Pieroni, MD; Giuseppina Fioravanti, CTER; Nicola Gentiloni, MD; Attilio Maseri, MD; Giovanni Gasbarrini, MD. Celiac Disease Associated With Autoimmune Myocarditis. (Circulation. 2002;105:2611.)
23. Malena Cohen-Cymberknoh1, Michael Wilschanski2 Concomitant cystic fibrosis and coeliac disease: reminder of an important clinical lesson. BMJ Case Reports 2009 [doi:10.1136/bcr.07.2008.0578].
24. Davidson DC, Shannon RS. Letter: Cystic fibrosis and coeliac disease. Arch Dis Child. 1974 Jun;49(6):501.
25. Franklin JL, Asquith P, Rosenberg IH. The occurrence of cystic fibrosis and celiac sprue within a single sibship. Am J Dig Dis. 1974 Feb;19(2):149-55.
26. Hide DW, Burman D. An infant with both cystic fibrosis and coeliac disease. Arch Dis Child. 1969 Aug;44(236):533-5.
27. Goodchild MC, Nelson R, Anderson CM. Cystic fibrosis and coeliac disease: coexistence in two children. Arch Dis Child 1973 Sep;48(9):684-91.
28. Katz AJ, Falchuk ZM, Schwachman H. The coexistence of cystic fibrosis and celiac disease. Pediatrics. 1976 May;57(5):715-21.
29. Santer R, Harms HK. [Cystic fibrosis and celiac disease. Report of two cases]. Monatsschr Kinderheilkd. 1990 Sep;138(9):623-6.
30. Chiaravalloti G, Baracchini A, Rossomando V, Ughi C, Ceccarelli M. [Celiac disease and cystic fibrosis: casual association?]. Minerva Pediatr. 1995 Jan-Feb;47(1-2):23-6.
31. Venuta A, Bertolani P, Casarini R, Ferrari F, Guaraldi N, Garetti E. [Coexistence of cystic fibrosis and celiac disease. Description of a clinical case and review of the literature]. Pediatr Med Chir. 1999 Sep-Oct;21(5 Suppl):223-6.
32. G. Fluge, H. Olesen, M. Gilljam, P. Meyer, T. Pressler, O. Storrösten, F. Karpati, L. Hjelte. Co-morbidity of cystic fibrosis and celiac disease in Scandinavian cystic fibrosis patients. Journal of Cystic Fibrosis, Volume 8, Issue 3, Pages 198-202.
33. Conn DL, McDuffie FC, Holley KE, Schroeter AL. Immunologic mechanisms in systemic vasculitis. Mayo Clin Proc. 1976 Aug;51(8):511-8.
34. Vázquez Gomis RM, Izquierdo Fos I, Zapata A, Parra G, Chicano Marin FJ. [Dilated myocardiopathy as a form of presentation of coeliac disease in childhood.]. An Pediatr (Barc). 2009 Oct 9.
35. Prati D, Bardella MT, Peracchi M, Porretti L, Scalamogna M, Conte D. Antiendomysial antibodies in patients with end-stage heart failure. Am J Gastroenterol. 2002 Jan;97(1):218-9.
36. Nisheeth K. Goel, MD; Robert D. McBane, MD; and Patrick S. Kamath, MD. Cardiomyopathy Associated With Celiac Disease. Mayo Clinic Proc. 2005;80(5):674-676.
37. Ph. Camus, T.V. Colby. The Lung In Inflammatory Bowel Disease. Eur Respir J 2000; 15:5-10.
38. O.C. Ioachimescu, S. Sieber, A. Kotch. Idiopathic Pulmonary Haemosiderosis Revisited. Eur Respir J 2004;24;162-169.
39. Mario Curione, maria Barbato, Pietro Cugini, Silvia Amato, Silvia Da Ros, Simonetta Di Bona. Association of Cardiomyopathy And Celiac Disease: An Almost Diffuse But Still Less Known Entity. Arch Med Sci 2008; 4, 2:103-107.
40. Ackerman Z, Eliashiv S, Reches A, Zimmerman J. Neurological manifestations in celiac disease and vitamin E deficiency. J Clin Gastroenterol. 1989 Oct;11(5):603–605
41. Henri-Bhargava Alexandre, Melmed Calvin, Glikstein Rafael, and Schipper Hyman M. NEUROLOGIC IMPAIRMENT DUE TO VITAMIN E AND COPPER DEFICIENCIES IN CELIAC DISEASE. Neurology, Vol. 71, Issue 11, 860-861, September 9, 2008
42. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.
43. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.
44. Vincent Cottina,, Gael Cléricib, Nicole Fabienc, Hugues Roussetd and Jean-François Cordiera Celiac disease revealed by diffuse alveolar hemorrhage and heart block. Respiratory Medicine Extra Volume 2, Issue 3, 2006, Pages 89-91.
45. Maddalena Peracchi MD1, Cristina Trovato MD1, Massimo Longhi MD2, Maurizio Gasparin DSc2, Dario Conte MD1, Cristina Tarantino BSc1, Daniele Prati MD3 and Maria Teresa Bardella MD1 Tissue transglutaminase antibodies in patients with end-stage heart failure. The American Journal of Gastroenterology (2002) 97, 2850–2854; doi:10.1111/j.1572-0241.2002.07033.x.
46. Alessandro Luciani*,
, Valeria Rachela Villella
, Angela Vasaturo, Ida Giardino
, Valeria Raia¶, Massimo Pettoello-Mantovani*, Maria D’Apolito*, Stefano Guido,, Teresinha Leal||, Sonia Quaratino# and Luigi Maiuri2,*,** SUMOylation of Tissue Transglutaminase as Link between Oxidative Stress and Inflammation1. Published online July 22, 2009
The Journal of Immunology, 2009, 183, 2775 –2784.
47. Wong M, et el. Proximal Myopathy And Bone Pain As The Presenting Features Of Coeliac Disease. Ann Rheum Dis, 2002, 61(1):p87-8.
48. Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.
49. Albert Selva-O’Callaghan, MD, PhD 1 *, Francesc Casellas, MD, PhD 2, Ines de Torres, MD, PhD 3, Eduard Palou, MD, PhD 4, Josep M. Grau-Junyent, MD, PhD 5, Miquel Vilardell-Tarrés, MD, PhD 1 Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy. Muscle & Nerve, Volume 35 Issue 1, Pages 49 – 54. Published
50. Hadjivassiliou M, Maki M, Saunders DS, Williamson CA, Grunewald RA, Woodroof NM, Korponay-Szabo IR. Autoantibody Targeting of Brain and Intestinal Transglutaminase in Gluten Ataxia. Neurology 2006 Feb.14;66(3):373-7.
51. T Matsuzaka, H Tanaka, M Fukuda, M Aoki, Y Tsuji, and H Kondoh. Relationship between vitamin K dependent coagulation factors and anticoagulants (protein C and protein S) in neonatal vitamin K deficiency. Arch Dis Child. 1993 March; 68(3 Spec No): 297–302.
52. Jorge O, Jorge A, Camus G. Celiac disease associated with antiphospholipid syndrome. Rev Esp Enferm Dig. 2008 Feb;100(2):102-3.
53. Armando D’Angelo, Silvana Viganò D’Angelo. Protein S deficiency. Haematologica, Vol 93, Issue 4, 498-501 doi:10.3324/haematol.12691
54. E Myrsky,* K Kaukinen,† M Syrjänen,* I R Korponay-Szabó,‡ M Mäki,* and K Lindfors* Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis. Clin Exp Immunol. 2008 April; 152(1): 111–119.
55. Deepak Gupta1 and Naureen Mirza1 Systemic lupus erythematosus, celiac disease and antiphospholipid antibody syndrome: a rare association. Journal Rheumatology International, Volume 28, Number 11 / September, 2008.
56. R Shamir, Y Shoenfeld, M Blank, R Eliakim, N Lahat, E Sobel, E Shinar, A Lerner. The prevalence of coeliac disease antibodies in patients with the antiphospholipid syndrome. Division of Paediatric Gastroenterology and Nutrition, Meyer Children’s Hospital of Haifa, Haifa, Israel, shamirr@netvision.net.il. Department of Paediatrics, Carmel Medical Center, Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
57. P.Rush, R.Inman, M.Bernstein, P.Carlen, L.Resch. Isolated vasculitis of the central nervous system in a patient with celiac disease. The American Journal of Medicine, Volume 81, Issue 6, Pages 1092-1094
58. S Meyers, S Dikman, H Spiera, N Schultz, H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut 1981;22:61-64; doi:10.1136/gut.22.1.61
59. V. Alegre, R. Winkelmann, J. Diez-Martin, P. Banks. Adult celiac disease, small and medium vessel cutaneous necrotizing vasculitis, and T cell lymphoma† Journal of the American Academy of Dermatology, Volume 19, Issue 5, Pages 973-978.
60. Siiri E. Iismaa, Bryony M. Mearns, Laszlo Lorand and Robert M. Graham. Transglutaminases and Disease: Lessons From Genetically Engineered Mouse Models and Inherited Disorders. Physiol. Rev. 89: 991-1023, 2009.
61. Luigi Maiuri2,*,, Alessandro Luciani,, Ida Giardino, Valeria Raia¶, Valeria R. Villella||, Maria D’Apolito, Massimo Pettoello-Mantovani, Stefano Guido||, Carolina Ciacci, Mariano Cimmino#, Olivier N. Cexus**, Marco Londei,* and Sonia Quaratino2,**, Tissue Transglutaminase Activation Modulates Inflammation in Cystic Fibrosis via PPAR
Down-Regulation1 The Journal of Immunology, 2008, 180, 7697 –7705.
61. Vincent Cottina, , , Gael Cléricib, Nicole Fabienc, Hugues Roussetd and Jean-François Cordiera Celiac disease revealed by diffuse alveolar hemorrhage and heart block. Respiratory Medicine Extra Volume 2, Issue 3, 2006, Pages 89-91.
62. Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007.
63 James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002.
64. Jefferson dams. Celiac G+ Antibody Assay for the Detection of Auto-antibodies in Celiac Disease. http://www.celiac.com/articles/21919/1/Celiac-G-Antibody-Assay-for-the-Detection-of-Auto-antibodies-in-Celiac-Disease/Page1.html
65. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.
66. Hadjivassilou M and Grünwald RA, Davies-Jones GAB. Gluten Sensitivity As a Neurological Illness. Journal of Neurology, Neurosurgery, and Psychiatry 2002;72:560-563
67. School of Medicine News: University of Maryland School of Medicine Scientists Pinpoint Critical Molecule to Celiac, Possibly Other Autoimmune Disorders. Tuesday, September 29, 2009. http://somvweb.som.umaryland.edu/absolutenm/templates/?a=915
68. Diet and Human Immune Function by David A. Hughes, L. Gail Darlington, and Adrianne Bendich. Humana Press; 1 edition (Dec 4 2003)
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