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Studies carried out using epithelial cell lines and animal models showed that gliadin was able to induce apoptosis of intestinal epithelial cells through a direct toxic effect (251), including enterocyte atrophy, villi shortening, decreased epithelial disaccharidase activity, increased expression of HLA molecules, and intraepithelial inflammatory activation

doi:10.1016/0009-2797(94)90071-x 15 Butawan M, Benjamin RL, Bloomer RJ

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Chronic liver injury induces conversion of biliary epithelial cells into hepatocytes

First, rule out any underlying conditions such as kidney or liver disease, cancer, or other blood disorders, as these can raise B12 levels

Low normal B12 level was defined as B12 level ranging between 190 and 300 pg/ml