<s>[INST] context: Almost all individuals with celiac disease share the major histocompatibility complex II HLA-DQ 2 or HLA - DQ8.
Gliadin is deamidated by the enzyme transglutaminase and deamidated gliadin peptides bind to DQ2 and DQ8.
Recognition of these peptides by CD4 + T cells leads to secretion of IFN-γ, which damages the intestinal wall.

Pathophysiology

Celiac disease is caused by the action of acidic peptides containing the gliadin fraction of wheat.
The basic abnormality is thought to be an increased rate of loss of epithelial cells. Crypt cells show increased activity. This causes hypertrophy of crypt. But even this increased activity cannot keep pace with the loss of cells, resulting in a progressive decrease in height of villi causing villous atrophy
 The epithelial cells show decreased cytoplasm and mucus
The intestinal biopsy shows a decrease in the villas: crypt ratio. Normally the villi are 3-4 times the height of the crypts (ratio of 3-4: 1); in celiac disease, the ratio decreases progressively (partial, subtotal and total villous atrophy). Total villous atrophy is seen in severe celiac disease and is quite characteristic of celiac disease (partial villous atrophy may be seen in many other conditions). [/INST] question: Gluten-sensitive enteropathy is most strongly associated with - | options: A: HLA-DQ2 B: HLA-DR4 C: HLA-DQ3 D: Blood group B | answer: A </s>