Hostname: page-component-797576ffbb-5676f Total loading time: 0 Render date: 2023-12-04T13:08:49.742Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Modulation of immune function by dietary lectins in rheumatoid arthritis

Published online by Cambridge University Press:  09 March 2007

Loren Cordain*
Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
L. Toohey
Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
M. J. Smith
Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
M. S. Hickey
Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA
*Corresponding author: Dr Loren Cordain, fax +1 970 491 0445, email
Rights & Permissions [Opens in a new window]


Core share and HTML view are not possible as this article does not have html content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Despite the almost universal clinical observation that inflammation of the gut is frequently associated with inflammation of the joints and vice versa, the nature of this relationship remains elusive. In the present review, we provide evidence for how the interaction of dietary lectins with enterocytes and lymphocytes may facilitate the translocation of both dietary and gut-derived pathogenic antigens to peripheral tissues, which in turn causes persistent peripheral antigenic stimulation. In genetically susceptible individuals, this antigenic stimulation may ultimately result in the expression of overt rheumatoid arthritis (RA) via molecular mimicry, a process whereby foreign peptides, similar in structure to endogenous peptides, may cause antibodies or T-lymphocytes to cross-react with both foreign and endogenous peptides and thereby break immunological tolerance. By eliminating dietary elements, particularly lectins, which adversely influence both enterocyte and lymphocyte structure and function, it is proposed that the peripheral antigenic stimulus (both pathogenic and dietary) will be reduced and thereby result in a diminution of disease symptoms in certain patients with RA.

Review article
Copyright © The Nutrition Society 2000


Albani, S and Carson, DA (1996) A multistep molecular mimicry hypothesis for the pathogenesis of rheumatoid arthritis. Immunology Today 17, 466470.Google Scholar
Albani, S, Tuckwell, J, Esparza, L, Carson, DA and Roudier, J (1992) The susceptibility sequence to rheumatoid arthritis is a cross-reactive B epitope shared by the Escherichia coli heat shock protein DnaJ and the HLA DRB1*0401 molecule. Journal of Clinical Investigation 89, 327331.Google Scholar
Auger, I and Roudier, J (1997) A function for the QKRAA amino acid motif: mediating binding of DnaJ to DnaK. Implications for the association of rheumatoid arthritis with HLA-DR4. Journal of Clinical Investigation 99, 18181822.Google Scholar
Banwell, JG, Howard, R, Kabir, I and Costerton, JW (1988) Bacterial overgrowth by indigenous microflora in the phytohemagglutinin-fed rat. Canadian Journal of Microbiology 34, 10091013.Google Scholar
Baum, H, Davies, H and Peakman, M (1996) Molecular mimicry in the MHC: hidden clues to autoimmunity. Immunology Today 17, 6470.Google Scholar
Baum, H and Staines, NA (1997) MHC-derived peptides and the CD4+ T-cell repertoire: implications for autoimmune disease. Cytokines, Cellular and Molecular Therapy 3, 115126.Google Scholar
Benno, P, Alam, M, Henriksson, K, Norin, E, Uribe, A and Midtvedt, T (1994) Abnormal colonic microbial function in patients with rheumatoid arthritis. Scandinavian Journal of Rheumatology 23, 311315.Google Scholar
Berg, RD (1992) Bacterial translocation from the gastrointestinal tract. Journal of Medicine 23, 217244.Google Scholar
Beri, D, Malaviya, AN, Shandilya, R and Singh, RR (1988) Effect of dietary restrictions on disease activity in rheumatoid arthritis. Annals of the Rheumatic Diseases 47, 6977.Google Scholar
Bevan, MJ, Hogquist, KA and Jameson, SC (1994) Selecting the T-cell repertoire. Science 264, 796797.Google Scholar
Bjarnason, I and Peters, TJ (1996) Influence of anti-rheumatic drugs on gut permeability and on the gut associated lymphoid tissue. Baillières Clinical Rheumatology 10, 165176.Google Scholar
Bjarnason, I, Peters, TJ and Wise, RJ (1984) The leaky gut of alcoholism: possible route of entry for toxic compounds. Lancet i, 179182.Google Scholar
Bourne, JT, Kumar, P, Huskison, EC, Maged, R, Unsworth, DJ and Wojtulewski, JA (1985) Arthritis and coeliac disease. Annals of the Rheumatic Diseases 44, 592594.Google Scholar
Brady, PG, Vannier, AM and Banwell, JG (1978) Identification of the dietary lectin, wheat germ agglutinin, in human intestinal contents. Gastroenterology 75, 236239.Google Scholar
Brauer, RThoss, KHenzgen, S & Waldman, G (1985) Lectin-induced arthritis of rabbit as a model of rheumatoid arthritis. In Lectins, vol. IV:, pp. 2938 [Bog-Hansen, TC and van Driessche, E, editors]. Berlin: Walter de Gruyter & Company.Google Scholar
Buchanan, HM, Preston, SJ, Brooks, PM and Buchanan, WW (1991) Is diet important in rheumatoid arthritis?. British Journal of Rheumatology 30, 125134.Google Scholar
Cao, W, Tykodi, SS, Esser, MT, Braciale, VL and Braciale, TJ (1995) Partial activation of CD8+ T cells by a self-derived peptide. Nature 378, 295298.Google Scholar
Charkravarty, K and Scott, DGI (1992) Oligoarthritis — a presenting feature of occult coeliac disease. British Journal of Rheumatology 31, 349350.Google Scholar
Chicz, RM, Urban, RG, Gorga, JC, Vignali, DA, Lane, WS and Strominger, JL (1993) Specificity and promiscuity among naturally processed peptides bound to HLA-DR alleles. Journal of Experimental Medicine 178, 2747.Google Scholar
Clevers, HC, De Bresser, A, Kleinveld, H, Gmelig-Meyling, FHJ and Ballieux, RE (1986) Wheat germ agglutinin activates human T lymphocytes by stimulation of phosphoinositide hydrolysis. Journal of Immunology 136, 31803183.Google Scholar
Collin, P and Maki, M (1994) Associated disorders in coeliac disease: clinical aspects. Scandinavian Journal of Gastroenterology 29, 769775.Google Scholar
Crissinger, KD, Kvietys, PR and Granger, DN (1990) Pathophysiology of gastrointestinal mucosal permeability. Journal of Internal Medicine 732 (Suppl.), 145154.Google Scholar
Dalton, TA and Bennett, JC (1992) Autoimmune disease and the major histocompatibility complex: therapeutic implications. American Journal of Medicine 92, 183188.Google Scholar
Darlington, LG, Ramsey, NW and Mansfield, JR (1986) Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet i, 236238.Google Scholar
Doherty, M and Barry, RE (1981) Gluten-induced mucosal changes in subjects without overt small-bowel disease. Lancet i, 517520.Google Scholar
Eerola, E, Mottonen, T, Hannonen, P, Luukkainen, R, Kantola, I, Vuori, K, Tuominen, J and Toivanen, P (1994) Intestinal flora in early rheumatoid arthritis. British Journal of Rheumatology 33, 10301038.Google Scholar
Fabia, R Ar'Rajab A, Johansson, ML, Willen, R, Andersson, R, Molin, G and Bengmark, S (1993) The effect of exogenous administration of. Lactobacillus reuteri R2LC and oat fiber on acetic acid-induced colitis in the rat. Scandinavian Journal of Gastroenterology 28, 155162.Google Scholar
Firestein, GS, Alvaro-Gracia, JM and Maki, R (1990) Quantitative analysis of cytokine gene expression in rheumatoid arthritis. Journal of Immunology 144, 3334733353.Google Scholar
Goronzy, JJ and Weyland, CM (1993) Interplay of T lymphocytes and HLA-DR molecules in rheumatoid arthritis. Current Opinion in Rheumatology 5, 169177.Google Scholar
Grant, G, More, LJ McKenzie NH and Pusztai, A (1982) The effect of heating on the haemagglutinating activity and nutritional properties of bean (. Phaseolus vulgaris) seeds. Journal of the Science of Food and Agriculture 33, 13241326.Google Scholar
Greer, F and Pusztai, A (1985) Toxicity of kidney bean (. Phaseolus vulgaris) in rats: changes in intestinal permeability. Digestion 32, 4246.Google Scholar
Griffiths, RJ (1992) Characterisation and pharmacological sensitivity of antigen arthritis induced by methylated bovine serum albumin in the rat. Agents and Actions 35, 8895.Google Scholar
Grossman, JM and Brahn, E (1997) Rheumatoid arthritis: current clinical and research directions. Journal of Womens Health 6, 627638.Google Scholar
Hamilton, I, Cobden, I, Rothwell, J and Axon, ATR (1982) Intestinal permeability in coeliac disease: the response to gluten withdrawal and single-dose gluten challenge. Gut 23, 202210.Google Scholar
Haugen, MA, Kjeldsen-Dragh, J and Forre, O (1994) A pilot study of the effect of an elemental diet in the management of rheumatoid arthritis. Clinical and Experimental Rheumatology 12, 275279.Google Scholar
Hazenberg, MP, Klassen, IS, Kool, J Ruseler-van Embden, JG and Severijnen, AJ (1992) Are intestinal bacteria involved in the etiology of rheumatoid arthritis?. APMIS 100, 19.Google Scholar
Henriksson, AE, Blomquist, L, Nord, CE, Midtvedt, T and Uribe, A (1993) Small intestinal bacterial overgrowth in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 52, 503510.Google Scholar
Husby, S, Jensenius, JC and Svehag, SE (1985) Passage of undegraded dietary antigen into the blood of healthy adults. Scandinavian Journal of Immunology 22, 8392.Google Scholar
Jameson, SC, Hogquist, KA and Bevan, MJ (1995) Positive selection and thymocytes. Annual Review of Immunology 13, 93126.Google Scholar
Karska, K, Tuckova, L, Steiner, L, Tlaskalova-Hogenova, H and Michalak, M (1995) Calreticulin — the potential autoantigen in celiac disease. Biochemical and Biophysical Research Communications 209, 597605.Google Scholar
Katz, KD and Hollander, D (1989) Intestinal mucosal permeability and rheumatological diseases. Baillières Clinical Rheumatology 3, 271284.Google Scholar
Kavanaghi, R, Workman, E, Nash, P, Smith, M, Hazleman, BL and Hunter, JO (1995) The effects of elemental diet and subsequent food reintroduction on rheumatoid arthritis. British Journal of Rheumatology 34, 270273.Google Scholar
Keshavarzian, A, Fields, JZ, Vaeth, J and Holmes, EW (1994) The differing effects of acute and chronic alcohol on gastric and intestinal permeability. American Journal of Gastroenterology 89, 22052211.Google Scholar
Kjeldsen-Kragh, J, Haugen, M, Borchgrevink, CF, Laerum, E, Eek, M, Mowinkel, P, Hovi, K and Forre, O (1991) Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 338, 899902.Google Scholar
Klasen, IS, Melief, MJ van Halteren, AG, Schouten, WR van Blankenstein, M, Hoke, G, de Visser, H, Hooijkaas, H and Hazenberg, MP (1994) The presence of peptidoglycan-polysaccharide complexes in the bowel wall and the cellular responses to these complexes in Crohn's disease. Clinical Immunology and Immunopathology 71, 303308.Google Scholar
Koch, AE, Shah, MR, Harlow, LA, Lovis, RM and Pope, RM (1994) Soluble intercellular adhesion molecule-1 in arthritis. Clinical Immunology and Immunopathology 71, 208215.Google Scholar
Kool, J Gerits-Boeye MY, Severijnen, AJ and Hazenberg, MP (1992) Immunohistology of joint inflammation induced in rats by cell wall fragments of. Eubacterium aerofaciens. Scandinavian Journal of Immunology 36, 497506.Google Scholar
La Cava, A, Nelson, JL, Ollier, WER, MacGregor, A, Keystone, EC, Thorne, JC, Scavulli, JF, Berry, CC, Carson, DA and Albani, S (1997) Genetic bias in immune responses to a cassette shared by different microorganisms in patients with rheumatoid arthritis. Journal of Clinical Investigation 100, 658663.Google Scholar
Lepore, L, Martelossi, S, Pennesi, M, Falcini, F, Ermini, ML, Ferrari, R, Perticarari, S, Presani, G, Lucchesi, A, Lapini, M and Ventura, A (1996) Prevalence of celiac disease in patients with juvenile arthritis. Journal of Pediatrics 129, 311313.Google Scholar
Lepore, L, Pennesi, M, Ventura, A, Torre, G, Falcini, F, Lucchesi, A and Perticarari, S (1993) Anti-alpha-gliadin antibodies are not predictive of coeliac disease in juvenile chronic arthritis. Acta Paediatrica 82, 569573.Google Scholar
Liener, IE (1986) Nutritional significance of lectins in the diet. In The Lectins: Properties, Functions and Applications in Biology and Medicine, pp. 527552 [Liener, IE, Sharon, N and Goldstein, IJ, editors]. Orlando, FL: Academic Press.Google Scholar
Lowes, JR, Radwan, P, Priddle, JD and Jewell, DP (1992) Characterisation and quantification of mucosal cytokine that induces epithelial histocompatibility locus antigen-DR expression in inflammatory bowel disease. Gut 33, 315319.Google Scholar
Lunardi, C, Bambara, LM, Biasi, D, Venturini, G, Nicholis, F, Pachor, ML and DeSandre, G (1988) Food allergy and rheumatoid arthritis. Clinical and Experimental Rheumatology 6, 423426.Google Scholar
Mageed, RA, Borretzen, M, Moyes, SP, Thompson, KM and Natvig, JB (1997) Rheumatoid factor autoantibodies in health and disease. Annals of the New York Academy of Sciences 815, 296311.Google Scholar
Mehta, SK, Kaur, S, Avasthi, G, Wig, NN and Chhuttani, PN (1972) Small intestinal deficit in pellagra. American Journal of Clinical Nutrition 25, 545549.Google Scholar
Mielants, H (1990) Reflections on the link between intestinal permeability and inflammatory joint disease. Clinical and Experimental Rheumatology 8, 523524.Google Scholar
Mowat, AM (1987) The regulation of immune responses to dietary protein antigens. Immunology Today 8, 9398.Google Scholar
Nardella, FA, Oppliger, IR, Stone, GC, Sasso, EH, Mannik, M, Sjoquist, J, Schroder, AK, Christensen, P, Johansson, PJ and Bjork, L (1998) Fc epitopes for human rheumatoid factors and the relationships of rheumatoid factors to the Fc binding proteins of microorganisms. Scandinavian Journal of Rheumatology 75 (Suppl.), 190198.Google Scholar
Nardella, FA, Teller, DC, Barber, CV and Mannik, M (1985) IgG rheumatoid factors and staphylococcal protein A bind to a common molecular site on IgG. Journal of Experimental Medicine 162, 18111824.Google Scholar
Nossal, GJV (1994) Negative selection of lymphocytes. Cell 76, 229239.Google Scholar
Odeh, M (1997) New insights into the pathogenesis and treatment of rheumatoid arthritis. Clinical Immunology and Immunopathology 83, 103116.Google Scholar
O'dell, JR, Haire, CE, Palmer, W, Drymalski, W, Wees, S, Blakely, K, Churchill, M, Eckhoff, PJ, Weaver, A, Doud, D, Erikson, N, Dietz, F, Olson, R, Maloley, P, Klassen, LW and Moore, GF (1997) Treatment of early rheumatoid arthritis with minocylcline or placebo: results of a randomized, double-blind, placebo-controlled trial. Arthritis and Rheumatism 40, 842848.Google Scholar
O'Farrelly, C, Marten, D, Melcher, D, McDougall, B, Price, R, Goldstein, AJ, Sherwood, R and Fernandes, L (1988) Association between villous atrophy in rheumatoid arthritis and a rheumatoid factor and gliadin-specific IgG. Lancet ii, 819822.Google Scholar
O'Farrelly, C, Price, R McGillivray AJ and Fernandes, L (1989) IgA rheumatoid factor and IgG dietary protein antibodies are associated in rheumatoid arthritis. Immunology Investigations 18, 753764.Google Scholar
Ohashi, F, Shimada, T, Sakaurai, M, Ishihara, S, Kuwamura, M, Yamate, J and Ota, M (1996) The production of arthritis in beagles by an immunological reaction to bovine serum albumin. Experimental Animals 45, 299307.Google Scholar
Oldstone, MBA (1987) Molecular mimicry and autoimmune disease. Cell 50, 819820.Google Scholar
Ostenstad, B, Dybwad, A, Lea, T, Forre, O, Vinje, O and Sioud, M (1995) Evidence for monoclonal expansion of synovial T cells bearing V alpha 2.1/V beta 5.5 gene segments and recognizing a synthetic peptide that shares homology with a number of putative autoantigens. Immunology 86, 168175.Google Scholar
Panush, RS, Stroud, RM and Webster, EM (1986) Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. Arthritis and Rheumatism 29, 220226.Google Scholar
Parke, AL and Hughes, GRV (1981) Rheumatoid arthritis and food: a case study. British Medical Journal 282, 20272029.Google Scholar
Perez-Maceda, B, Lopez-Bote, JP, Langa, C and Bernabeu, C (1991) Antibodies to dietary antigens in rheumatoid arthritis — possible molecular mimicry mechanism. Clinica Chimica Acta 203, 153165.Google Scholar
Peumans, WJ & Cammue, BPA (1986) Gramineae lectins: a special class of plant lectins. In Lectins — Biology, Biochemistry, Clinical Biochemistry, vol. 5, pp. 3137 [Bog-Hansen, TC and van Driessche, E, editors]. Berlin: Walter de Gruyter & Company.Google Scholar
Piccinini, LA, Mackenzie, WA, Platzer, M and Davis, TF (1987) Lymphokine regulation of HLA-DR gene expression in human thyroid cell monolayers. Journal of Clinical Endocrinology and Metabolism 64, 543548.Google Scholar
Pusztai, A (1989) Transport of proteins through the membranes of the adult gastrointestinal tract — a potential for drug delivery?. Advances in Drug Delivery Reviews 3, 215228.Google Scholar
Pusztai, A (1989 b) Lectins. In Toxicants of Plant Origin, vol. III, pp. 2971 [Cheeke, PR, editor]. Boca Raton, FL: CRC Press.Google Scholar
Pusztai, A (1993) Dietary lectins are metabolic signals for the gut and modulate immune and hormone functions. European Journal of Clinical Nutrition 47, 691699.Google Scholar
Pusztai, A, Ewen, SWB, Grant, G, Brown, DS, Stewart, JC, Peumans, WJ, Van Damme, EJM and Bardocz, S (1993) Antinutritive effects of wheat-germ agglutinin and other. N-acetylglucosamine-specific lectins. British Journal of Nutrition 70, 313321.Google Scholar
Pusztai, A, Ewen, SWB, Grant, G, Peumans, WJV, an Damme, EJM, Rubio, LA & Bardocz, S (1991) Plant (food) lectins as signal molecules: effects on the morphology and bacterial ecology of the small intestine. In Lectin Reviews, vol. 1, pp. 115 [Kilpatrick, DC, Van Driessche, E and Bog-Hansen, TC, editors]. St Louis, MO: Sigma.Google Scholar
Pusztai, A, Grant, G, Spencer, RJ, Duguid, TJ, Brown, DS, Ewen, SWB, Peumans, WJ, Van Damme, EJM and Bardocz, S (1993) Kidney bean lectin-induced. Escherichia coli overgrowth in the small intestine is blocked by GNA, a mannose-specific lectin. Journal of Applied Bacteriology 75, 360368.Google Scholar
Pusztai, A, Greer, F and Grant, G (1989) Specific uptake of dietary lectins into the systemic circulation of rats. Biochemical Society Transcations 17, 527528.Google Scholar
Rath, HC, Herfarth, H, Ikeda, JS, Grenther, WB, Hamm, TE, Balish, E, Taurog, JD, Hammer, RE, Wilson, KH and Sartor, B (1996) Normal luminal bacteria, especially bacteroides species, mediate chronic colitis, gastritis, and arthritis in HLA-B27/Human B2 microglobulin transgenic rats. Journal of Clinical Investigation 98, 945953.Google Scholar
Rattray, EAS, Palmer, R and Pusztai, A (1974) Toxicity of kidney beans (Phaseolus vulgaris L.) to conventional and gnotobiotic rats. Journal of the Science of Food and Agriculture 25, 10351040.Google Scholar
Riordan, AM, Hunter, JO, Cowan, RE, Crampton, JR, Davidson, AR, Dickinson, RJ, Dronfield, MW, Fellows, IW, Hishon, S and Kerrigan, GN (1993) Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 342, 11311134.Google Scholar
Roudier, J, Petersen, J, Rhodes, G, Luka, J and Carson, DA (1989) Susceptibility to rheumatoid arthritis maps to a T cell epitope shared by the HLA Dw4 DR beta 1 chain and the Epstein Barr virus glucoprotein gp110. Proceedings of the National Academy of Sciences USA 86, 51045108.Google Scholar
Routsias, JG, Tzioufas, AG Sakarellos-Daitsiotis M, Sakarellos, C and Moutsopoulos, HM (1993) Calreticulin synthetic peptide analogues: anti-peptide antibodies in autoimmune rheumatic diseases. Clinical and Experimental Immunology 91, 437441.Google Scholar
Rowley, MJ, Stockman, A, Brand, CA, Tait, BD, Rowley, GL, Sherritt, MA, Mackay, IR, Muirden, KD and Bernard, CC (1997) The effect of HLA-DRB1 disease susceptibility markers on the expression of RA. Scandinavian Journal of Rheumatology 26, 448455.Google Scholar
Ryder, SD, Smith, JA and Rhodes, JM (1992) Peanut lectin: a mitogen for normal human colonic epithelium and human HT29 colorectal cancer cells. Journal of the National Cancer Institute 84, 14101416.Google Scholar
Sartor, RB (1989) Importance of intestinal mucosal immunity and luminal bacterial cell wall polymers in the aetiology of inflammatory joint disease. Baillières Clinical Rheumatology 3, 223245.Google Scholar
Sartor, RB, Rath, HC, Lichtman, SN and van Tol, EA (1996) Animal models of intestinal and joint inflammation. Baillières Clinical Rheumatology 10, 5576.Google Scholar
Shatin, R (1964) Preliminary report of the treatment of rheumatoid arthritis with high protein gluten free diet and supplementation. Medical Journal of Australia 2, 169172.Google Scholar
Shingú, M, Hashimoto, M, Nobunaga, M, Isayama, T, Yasutake, C and Naono, T (1994) Production of soluble ICAM-1 by mononuclear cells from patients with rheumatoid arthritis. Inflammation 18, 2334.Google Scholar
Sjolander, A, Magnusson, KE and Latkovic, S (1984) The effect of concanavalin A and wheat germ agglutinin on the ultrastructure and permeability of rat intestine. International Archives of Allergy and Applied Immunology 75, 230236.Google Scholar
Sjolander, A, Magnusson, KE and Latkovic, S (1986) Morphological changes of rat small intestine after short-time exposure to concanavalin A or wheat germ agglutinin. Cell Structure and Function 11, 285293.Google Scholar
Smith, MD, Gibson, RA and Brooks, PM (1985) Abnormal bowel permeability in ankylosing spondylitis and rheumatoid arthritis. Journal of Rheumatology 12, 299305.Google Scholar
Sutton, BJ, Corper, AL, Sohi, MK, Jefferis, R, Beale, D and Taussig, MJ (1998) The structure of a human rheumatoid factor bound to IgG Fc. Advances in Experimental Medicine and Biology 435, 4150.Google Scholar
Taurog, JD, Richardson, JA, Croft, JT, Simmons, WA, Zhou, M Fernandez-Sueiro JL, Balish, E and Hammer, RE (1994) The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats. Journal of Experimental Medicine 180, 23592364.Google Scholar
Thomsen, P, Bjursten, LM, Ahlstedt, S, Bagge, U and Ericson, LE (1985) Proliferative synovitis in rabbit knee joints induced by antigen and preformed immune complexes. Scandinavian Journal of Rheumatology 14, 239251.Google Scholar
Travis, S and Menzies, I (1992) Intestinal permeability: functional assessment and significance. Clinical Science 82, 471488.Google Scholar
Trentham, DE and Dynesius-Trentham, RA (1995) Antibiotic therapy for rheumatoid arthritis. Scientific and anecdotal appraisals. Rheumatic Disease Clinics in North America 21, 817834.Google Scholar
Tsuda, M (1979) Purification and characterization of a lectin from rice bran. Journal of Biochemistry 86, 14511461.Google Scholar
Udey, MC, Chaplin, DD, Wedner, HJ and Parker, CW (1980) Early activation events in lectin stimulated human lymphocytes: evidence that wheat germ agglutinin and mitogenic lectins cause similar early changes in lymphocyte metabolism. Journal of Immunology 125, 15441550.Google Scholar
van de Laar, MA and van der Korst, JK (1992) Food intolerance in rheumatoid arthritis. I. A double blind, controlled trial of the clinical effects of elimination of milk allergens and azo dyes. Annals of the Rheumatoid Diseases 51, 298302.Google Scholar
van den Bourne, BE, Kijkmans, BA, de Rooij, HH, le Cessie, S and Verweij, CL (1997) Chloroquine and hydroxychloroquine equally affect tumor necrosis factor-alpha, interleukin-6, and interferon-gamma production by peripheral blood mononuclear cells. Journal of Rheumatology 24, 5560.Google Scholar
Verreck, FA, Elferink, D, Vermeulen, CJ, Amons, R, Breedveld, F, de Vries, RR and Koning, F (1995) DR4Dw4/DR53 molecules contain a peptide from the autoantigen calreticulin. Tissue Antigens 45, 270275.Google Scholar
von Herrath, MG and Oldstone, MBA (1995) Role of viruses in the loss of tolerance to self-antigens and in autoimmune diseases. Trends in Microbiology 3, 424430.Google Scholar
Wagner, U, Kaltenhauser, S, Sauer, H, Arnold, S, Seidel, W, Hantzschel, H, Kalden, JR and Wassmuth, R (1997) HLA markers and prediction of clinical course and outcome in rheumatoid arthritis. Arthritis and Rheumatism 40, 341351.Google Scholar
Weetman, AP, Volkman, DJ, Burman, KD, Gerrard, TL and Fauci, AS (1985) The in vitro regulation of human thyrocyte HLA-DR antigen expression. Journal of Clinical Endocrinology and Metabolism 61, 817824.Google Scholar
Welsh, CJ, Hanglow, AC, Conn, P, Barker, TH and Coombs, RR (1985) Early rheumatoid-like synovial lesions in rabbits drinking cow's milk. Joint pathology. International Archives of Allergy and Applied Immunology 78, 145151.Google Scholar
Weyland, CM and Goronzy, JJ (1997) Pathogenesis of rheumatoid arthritis. Medical Clinics of North America 81, 2955.Google Scholar
Williams, R (1981) Rheumatoid arthritis and food: a case study. British Medical Journal 283, 563.Google Scholar
Williams, RC (1992) Rheumatoid factors: historical perspective, origins and possible role in disease Journal of Rheumatology 32 (Suppl.), 4245.Google Scholar
Williams, RC (1996) Autoimmune mechanisms involved in the pathogenesis of rheumatoid arthritis. Advances in Dental Research 10, 4751.Google Scholar
Wilson, AB, King, TP, Clarke, EMW and Pusztai, A (1980) Kidney bean (Phaseolus vulgaris) lectin-induced lesions in the small intestine. II. Microbiological studies. Journal of Comparative Pathology 90, 597602.Google Scholar
Wilson, C, Tiwana, H and Ebringer, A (1997) HLA-DR4 restriction, molecular mimicry and rheumatoid arthritis. Immunology Today 18, 9697.Google Scholar
Ziff, M (1983) Diet in the treatment of rheumatoid arthritis. Arthritis and Rheumatism 26, 457461.Google Scholar