Children with Celiac Disease Have Elevated Antimicrobial Peptide Levels in Their Gut

Children with active celiac disease had significantly elevated fecal β-defensin-2 levels (99.6 vs 64.0 ng/mL, p<0.001) and higher anti-BPI antibodies compared to healthy controls. Fecal calprotectin and β-defensin-2 were moderately correlated (r=0.69), and β-defensin-2 weakly correlated with anti-BPI antibodies (r=0.35). These findings suggest that antimicrobial peptides are part of the gut's innate immune response in celiac disease.

Case-control study of 76 children (ages 2-10) with recently diagnosed celiac disease and 32 age-matched healthy controls. Measured fecal β-defensin-2 and calprotectin levels in stool samples and anti-BPI antibodies in blood serum. Correlations between markers assessed using Pearson coefficient.

Celiac disease diagnosis and monitoring still rely heavily on invasive biopsies and antibody tests. Fecal biomarkers like β-defensin-2 could offer a non-invasive way to assess intestinal inflammation and immune activation in children with celiac disease, potentially helping track disease activity without repeated endoscopies.

Most celiac disease research focuses on the adaptive immune response (antibodies against gluten). This study highlights the role of innate immunity — the body's first-line defense — through antimicrobial peptides. Understanding how defensins and other AMPs respond in celiac disease could reveal new aspects of disease mechanisms and lead to non-invasive stool-based monitoring tools, which would be especially valuable for pediatric patients who are difficult to subject to repeated biopsies.

Relatively small sample size, especially the control group (32 children). Cross-sectional design cannot determine whether elevated AMPs are a cause or consequence of celiac inflammation. Did not follow patients after starting a gluten-free diet to see if biomarkers normalized. Age range limited to 2-10 years.