Celiac Treatments, Adjuvant Therapies and Alternatives to the Gluten-Free Diet

Justin L. McCarville, Alberto Caminero, Elena F. Verdu

Resumen


Celiac disease (CD) is a chronic enteropathy triggered by exposure to dietary gluten in genetically susceptible individuals. The only currently accepted therapy for CD is a lifetime gluten-free diet (GFD). Although a GFD has proven to be a safe and effective in most celiac patients, there are limitations that warrant new adjuvant therapies for the treatment of CD. The therapies in development for CD fall into the following categories 1) Gluten detoxification 2) Luminal therapies 3) Intestinal barrier enhancing therapies 4) Immune targeted therapies and 5) Experimental therapies. Gluten detoxification includes altering gluten proteins in foods before commercialization. Luminal therapies aim at neutralizing gluten in the lumen of the small intestine. These include enzymatic digestion therapy, probiotics and gluten binders. Barrier enhancing therapies decrease the leaky intestinal condition associated with the disease, which could enhance translocation of gluten peptides, or of other harmful antigens, into the lamina propria. Immune targeted therapies include TG2 blockers, HLA blockers, T cell targeted therapies, alteration of inflammatory mediators and vaccine therapy. Finally, experimental therapies comprise compounds or biological strategies in discovery phase. Of these, Elafin was recently proposed to play a role in CD and have potential therapeutic applications in an animal model. To date, none of the discussed therapies have been approved for clinical use and are at different stages of development. However, adjuvant therapies to the GFD will likely become a reality to the coming years and will increase the quality of life of patients living with gluten-related disorders.


Palabras clave


Therapies for CD, gluten free alternatives, celiac therapies, gluten detoxification, gluten proteolysis

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