New therapeutic strategies for celiac disease

Celiac disease is an autoimmune condition affecting genetically susceptible individuals, characterized by inflammatory damage to the small intestine following ingestion of wheat gluten or barley and rye products. The only life-long treatment is strict gluten-free diet which is difficult personally and socially, affects quality of life, not widely available, more expensive, with lower palatability, resulting in low compliance. No doubt, there is therefore an urgent need for alternative therapeutic modalities. Based on the increasing knowledge on the sequential pathophysiological events driving the intestinal inflammatory cascade, new attractive and potential therapies were starting to immerge: selecting, changing, degrading, manipulating or binding the dietary toxic environmental factors, decreasing intestinal permeability toward gluten or blocking the deamination of gluten by inhibiting tissue transglutaminase or the HLA-DQ presenting groove by carefully designed false peptide, shifting the typical Th1 to Th2 inflammatory reaction or antagonizing major proinflammatory cytokines, enhancing regulatory immune function or developing preventive vaccines, blocking adhesion molecule, inducing gluten oral or intranasal tolerance or applying epithelial repairing mitogens to oppose the mucosal destruction. Safety, effectiveness, cost and affordability are prime issues to consider. Some modalities have shown promising results in vitro. Future will show who will win the race.