Therapeutic options for coeliac disease: What else beyond gluten-free diet?

• Published in: Digestive and liver disease Vol. 52; no. 2; pp. 130 - 137
• Main Authors: Caio, Giacomo, Ciccocioppo, Rachele, Zoli, Giorgio, De Giorgio, Roberto, Volta, Umberto
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2020
• Subjects: Celiac Disease - immunology; Celiac Disease - therapy; Diet, Gluten-Free; Gliadin - immunology; Glutens - immunology; Humans; Immunosuppression; Immunotherapy; Intestinal Absorption; Larazotide acetate; Latiglutenase; Randomized Controlled Trials as Topic; Vaccine; GFD; GSRS; ELISpot; QoL; AN-PEP; IFN; MSCs; Th; Immunotherapy; TLR; MICA; CD; IELs; IL; Larazotide acetate; Vaccine; RCD; APC; JAK; La/Ma; Latiglutenase; HLA; MTD; TG2/tTG; TJs; NK
• ISSN: 1590-8658; 1878-3562; 1878-3562
• DOI: 10.1016/j.dld.2019.11.010

Coeliac disease is a chronic and systemic autoimmune condition triggered by gluten ingestion in genetically predisposed subjects. Currently, the only effective treatment available is a strict, lifelong gluten-free diet. However, patients perceive gluten withdrawal as an unsustainable burden in their life and some of them can exhibit persistent symptoms despite a strict diet. Thus, gluten-free diet represents a challenge, leading scientists to look for alternative or complementary treatments. This review will focus on non-dietary therapies for coeliac disease highlighting six therapeutic strategies: (1) decreasing gluten immunogenic content before it reaches the intestine; (2) sequestering gluten in the gut lumen before absorption; (3) blocking the passage of gluten through a leaky intestinal barrier; (4) preventing the enhancement of immune response against gliadin; (5) dampening the downstream immune activation; (6) inducing immune tolerance to gluten. Most developing therapies are only in the pre-clinical phase with only a few being tested in phase 2b or 3 trials. Although new approaches raise the hope for coeliacs giving them a chance to come back to gluten, for the time being a cautionary appraisal of new therapies suggests that they may have a complementary role to gluten withdrawal, mainly to prevent inadvertent gluten contamination.