key: cord-0997661-9xq2dasi authors: Trovato, Chiara Maria; Montuori, Monica; Pietropaoli, Nicoletta; Oliva, Salvatore title: COVID‐19 and celiac disease: A pathogenetic hypothesis for a celiac outbreak date: 2021-06-17 journal: Int J Clin Pract DOI: 10.1111/ijcp.14452 sha: 3ea0c881c5b196d6a4be2fd5dbbd1eebf1630b5c doc_id: 997661 cord_uid: 9xq2dasi BACKGROUND: A growing body of evidence supports the intestinal trophism of SARS‐CoV‐2, with ciliated cells and intestinal enterocytes being target cells because of the high expression of ACE2 and TMPRSS2. Indeed, COVID‐19 promotes a “cytokine storm” in the intestinal mucosa: the resulting epithelial damage leads to increased barrier permeability, allowing the passage of gliadin in the intestinal lamina. METHODS: Based on current literature, we hypothesize the role of COVID‐19 as a potential trigger factor for celiac disease in predisposed patients. CONCLUSIONS: Genetically predisposed patients could be more likely to develop celiac disease following SARS‐CoV‐2 infection, making COVID‐19 a candidate culprit for a potential outbreak of celiac disease in the forthcoming future. The outbreak of the new coronavirus disease caused by the coronavirus SARS-CoV-2, which quickly escalated to a pandemic, has changed the approach to healthcare. Lockdown and restriction measures have been advocated as potential strategies to contain the infection or, in other words, to "flatten the curve." However, the potential burden of the SARS-CoV-2 infection and the resulting disease is an open question, with no data currently available on the development of systemic disorder or on long-term consequences. We aim to highlight the potential risk of an "outbreak" of celiac disease Cellular and molecular pathways of COVID-19 and potential points of therapeutic intervention ACE2 and gut amino acid transport TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes Why is SARS-CoV-2 infection more severe in obese men? The gut lymphaticslung axis hypothesis TH17 responses in cytokine storm of COVID-19: an emerging target of JAK2 inhibitor Fedratinib Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis Role of the intestinal tight junction modulator zonulin in the pathogenesis of type I diabetes in BB diabetic-prone rats Tissue-mediated control of immunopathology in coeliac disease Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases Are alterations of tight junctions at molecular and ultrastructural level different in duodenal biopsies of patients with celiac disease and Crohn's disease? Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease Intestinal epithelium, intraepithelial lymphocytes and the gut microbiota -key players in the pathogenesis of celiac disease The risk of contracting COVID-19 is not increased in patients with celiac disease Prevalence of COVID-19 in Italian children with celiac disease: a cross-sectional study ESPGHAN 'biopsysparing' guidelines for celiac disease in children with low antitransglutaminase during COVID-19 Where have all the other coeliacs gone in 2020? Road for a 2021 catch-up with missed diagnoses A negative fallout of COVID-19 lockdown in Italy: life-threatening delay in the diagnosis of celiac disease Respiratory infections are temporally associated with initiation of type 1 diabetes autoimmunity: the TEDDY study Type 1 diabetes triggered by covid-19 pandemic: a potential outbreak? COVID-19 and celiac disease: A pathogenetic hypothesis for a celiac outbreak