The immune system in the GI tract, like in the rest of the body, can be subdivided into the following two categories: (1) cellular and (2) humoral. T-lymphocytes generally regulate cellular immune functions, such as defense against viruses, intracellular bacteria, and proteins, whereas B-lymphocytes produce immunoglobulins (Ig) to fight bacteria. Primary immunodeficiencies are the result of inherited defects in either or both the cellular or humoral branches of the immune system. In the GI tract, the major Igs are the secretory forms of IgA and IgM. These antibodies bind luminal antigens and form immune complexes, thus restricting bacterial and viral attachment to epithelium and decreasing antigen burden on the mucosal immune cells. Antibody deficiency can lead to increased antigen uptake in the GI tract, as has been demonstrated with serum levels of dietary antigens following feeding (Cunningham-Rundles et al, 1979). However, it is interesting to note in the one disease exclusively restricted to B-cells, X-linked agammaglobuline-mia (XLA), there has been no significant predisposition to GI infection or disease.
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