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By Norton Greenberger, Richard Blumberg, Robert Burakoff

Remarkable the appropriate stability among comprehensiveness and straightforwardness of use, this well known access within the present sequence grants high-yield insurance of the total spectrum of gastroenterology and hepatology in a streamlined, constant presentation.

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Moreover, genetic studies show that alterations of intestinal epithelial cell function and especially that of Paneth cells, which secrete antimicrobial peptides into the lumen, contribute to the pathogenesis of these diseases. This occurs through genes such as ATG16L1 (which regulates autophagy), XBP1 (which regulates the unfolded protein response), and NOD2 (which regulates intracellular bacterial sensing). In addition, the genes identified to date seem to associate with specific functional pathways that may be shared by CD and UC, as well as other immune-mediated diseases such as multiple sclerosis, type 1 diabetes mellitus, asthma, and others.

The innate immune system contains a pattern recognition system that provides a hard-wired and rapid response system for responding to microbial structures. A classic group of structures that are used by a wide variety of cell types in an innate immune response is the so-called toll-like receptors (TLRs), which respond to microbial structures as diverse as lipopolysaccharide or DNA of microbes. Another major class of pattern recognition receptors associated with innate immunity is the nucleotide oligomerization domain (NOD)-like receptors (NLRs), which recognize microbial structures such as muramyl dipeptide from the peptidoglycans of gram-negative and gram-positive bacteria.

2007;13:573–579. [PMID: 17345609] GENERAL PRINCIPLES OF THE GUTASSOCIATED LYMPHOID TISSUES The normal intestine has an enormous surface area that is exposed to a wide variety of exogenous, especially bacterial, antigens (Figure 2–2). Consequently, the mucosal immune system has had to develop a wide variety of very specific modifications and developmental structures to deal with and respond to these challenges. Importantly, the overwhelming majority of initial antigen encounters for the host occur at the mucosal surface, which is bathed by a heterogeneous population of microorganisms, most of which are congregated within the colon and distal small intestine where IBD most commonly occurs.

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