Thioldisulfide system status as a criterion for the effectiveness of pathogenetic therapy in patients with celiacia


L.S. Oreshko, E.A. Semenova, A.A. Karpov

North-West State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia
Background. In diseases of different etiology, a change in the oxidation-reduction process is observed, which is determined by the indices of the thioldisulfide ratio (TDR). TDR is an integral index of adaptive capabilities, which can be considered as an indicator of nonspecific resistance of the organism. The thioldisulfide system is characterized by the reversibility of the redox interconversions of thiols and disulfides (2-HS↔SS-+2H), which is considered as a phenomenon of disulfide bond formation, which underlies the biological regulation of the nonspecific adaptive response of the organism. According to a number of studies, in samples of biopsy specimens of the small intestine mucous membrane of celiac patients with exacerbation, low activity of antioxidant enzymes and a decrease in the glutathione levels are observed. Objective. Evaluation of the thioldisulfide system status in patients with celiac disease and the possibility of its use as a criterion for the effectiveness of the gluten-free diet (GFD). Methods. Patients with a verified diagnosis of «celiac disease» participated in the study. The examination included subjective examination and blood tests: HLA-typing, determination of the concentration of thiol-sulfide groups with calculation of thioldisulfide ratio (TDR), K=SH/SS. To confirm the effectiveness of compliance with GFD, a histomorphologic examination of the biopsy specimen of the duodenal mucosa was performed. Results. 81 patients with genetically confirmed diagnosis of celiac disease aged 19 to 65 years were examined. There was a significant decrease in TDR, indicating a violation of nonspecific resistance and an increase in free radical oxidation in examined patients. The increase in TDR with increase of duration of GFD indicates a decrease in antioxidant activity in patients with celiac disease on the background of pathogenetic treatment aimed at eliminating the factors that cause oxidative stress. Conclusion. The antioxidant effect of therapeutic nutrition by eliminating gluten from the diet helps to reduce the toxic damage of the intestinal epithelium and to increase the protective role of the intestinal barrier in patients with celiac disease, which is confirmed by an increase in the TDR and can serve as a diagnostic criterion for the effectiveness of therapy.
Keywords: thioldisulfide system, celiac disease, gluten-free diet, thioldisulfide equilibrium

About the Autors

Corresponding author: Ludmila S. Oreshko, MD, Professor of Department of Propaedeutics of Internal Diseases, Gastroenterology and Dietetics, North-West State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia; e-mail:
Address: 41, Kirochnaya Street, St. Petersburg 191015, Russian Federation

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